Anesthetic considerations for carotid endarterectomy.

Carotid endarterectomy (CEA) appears to be an intuitively logical operation which probably accounts for the incredible growth in its popularity since it was introduced in 1954. Between 1971 and 1985, the number of carotid endarterectomies performed increased from 15,000 to 107,000 cases per year in the USA. Between 1985 and 1990, the number of endarterectomies declined due to concerns voiced by prominent individuals about the paucity of evidence supporting its efficacy and safety given the reported wide variations in morbidity and mortality rates. As a result, a number of well-designed prospective, randomized trials were initiated comparing best available medical therapy versus best available medical therapy combined with endarterectomy. The salient results of some of the more important trials are shown in Table 1. Confirmation of the efficacy of the procedure, at least among selected patients, resulted in a rapid increase in the use of endarterectomy to > 140,000 annually in the United States.