PURPOSE: Since the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid @entity2791 Study (ACAS) established the efficacy of carotid endarterectomy at large academic centers, there have been two community-based studies of outcomes after this operation. The purpose of this study was to perform a statewide survey to evaluate postoperative morbidity and mortality after carotid endarterectomy among @entity1 throughout Maine. METHODS: A statewide registry was established to collect prospective data on carotid operations from January 1 to December 31, 1995. All surgeons and hospitals in the state were solicited to participate. All carotid endarterectomies were intended to be included; the only exclusion criterion was out-of-state residence. Comorbidities, preoperative studies, surgical indications, operative technique, and postoperative outcomes were analyzed. State administrative data were used to assess registry coverage. RESULTS: Ten of 17 hospitals participated, and 58% of all carotid endarterectomies performed in the state were included. Three hundred sixty-four operations were entered into the registry. Forty-four percent of the operations were performed for transient @entity63 attack, 37% for asymptomatic @entity850 , and 19% for @entity64 . The @entity64 rate was 2.5% with a total @entity16 rate of 4.7% (transient @entity63 attack and @entity64 ). There was one postoperative death (mortality rate 0.3%). @entity1 with symptoms had a higher incidence of @entity64 (4.0% vs 0% asymptomatic; p < 0.05) and transient @entity63 attacks (3.8% vs 0.8% asymptomatic). @entity64 rates varied from 0% to 7%. @entity64 rate did not differ significantly between low-volume hospitals (2 to 28 @entity1 /year, 3.3%) and high-volume hospitals (29 to 101 @entity1 /year, 2.3%) or between low-volume surgeons (fewer than 11 operations/year, 1.7%) and high-volume surgeons (more than 12 operations/year, 2.4%). Among 26 reporting surgeons, @entity64 rate varied from 0% to 10%; the absolute number of @entity64 per surgeon varied between zero and two. CONCLUSION: The statewide registry showed a @entity64 plus death rate of 2.8%, comparable with the NASCET and ACAS findings. Although this study had inherent limitations, the results from one state, including a variety of community practices, achieved results comparable with those of landmark trials.

Carotid endarterectomy after NASCET and ACAS: a statewide study. North American Symptomatic Carotid Endarterectomy Trial. Asymptomatic Carotid XXXX Study.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity64 :: ('MESH:D020521', 'Disease') :: ['strokes', 'Hospital stroke', 'stroke', 'postoperative stroke', 'Stroke'] @entity63 :: ('MESH:D007511', 'Disease') :: ['ischemic'] @entity16 :: ('MESH:D009422', 'Disease') :: ['neurologic complication'] @entity2791 :: ('MESH:D012078', 'Disease') :: ['Artery Stenosis'] @entity850 :: ('MESH:D003251', 'Disease') :: ['stenosis']
@entity2791 :: (MESH:D012078,Disease) :: ['Artery Stenosis']
