Carotid endarterectomy in a small community hospital.

Over a 10 year period carotid endarterectomy was performed in a total of 177 operations in 145 patients at a small community hospital. Mortality and morbidity rates were similar to those reported from larger medical centers. The use and comparison of intracerebral protective techniques of hypercarbia and shunting are discussed. Routine use of the Silastic shunt appears preferable to more elaborate means of cerebral protection. The noninvasive Dopscan and periorbital Doppler examination are effective tools in the selection of patients for surgery and follow-up of patients with asymptomatic bruits, contralateral stenoses or both. These noninvasive studies often add valuable information when the angiographic findings are uncertain. The treatment of asymptomatic carotid lesions remains controversial. Significant carotid stenosis or ulcerated plaque can be treated prophylactically by endarterectomy if the operator can show no hospital mortality and a reversible neurologic deficit of about 2 percent in his series.