Risks of carotid endarterectomy. Toronto Cerebrovascular Study Group.

An objective, retrospective review of 358 carotid endarterectomies performed in the neurosurgical teaching units of the University of Toronto in the year 1982 demonstrated a perioperative stroke rate of 3.9% and a death rate of 1.5%. Most (82%) surgical neurological complications occurred after the immediate post-operative period (24 hours). This high incidence of delayed stroke suggests that most perioperative strokes are embolic rather than hemodynamic. Careful operative technique and the use of anticoagulants and antiplatelet agents may be more important in preventing postoperative deficits than intraoperative monitoring and intraluminal shunting. Our figures and those of current published data indicate that a 5-6% combined morbidity and mortality should be expected in carotid endarterectomy. These data are critical both to decision making with the individual patient as well as in the planning of future carotid surgery trials.