Carotid endarterectomy in Durban--the first 10 years.

This study was a prospective evaluation of the Durban experience with carotid endarterectomy over the past decade. Since 1981, 478 carotid endarterectomies have been performed in 411 patients. The majority of these patients were white men, with an average age of 60.6 years. The indication for surgery was a lateralising transient ischaemic attack or amaurosis fugax in 65.5%, lateralising stroke (< 1 year before surgery) in 14.4%, non-lateralising global cerebral ischaemia in 9.4% and asymptomatic carotid stenosis in 10.7%. Carotid endarterectomy was performed under general anaesthesia and with invasive monitoring; 25% of patients underwent selective shunting. After open carotid bifurcation endarterectomy, all but 6 underwent primary closure (99.4%). The combined major stroke/mortality rate was 6%. This audit identified a group of patients who presented with a history of stroke within the year preceding surgery and who had a significantly higher postoperative stroke/mortality rate of 20.2%. Long-term follow-up, ranging from 1 month to 96 months, showed 80.7% to be stroke-free after 8 years. This audit demonstrates a postoperative stroke/mortality rate comparable to that of other series and additionally confirmed the durability of carotid endarterectomy in the long term.