Surgical techniques and perioperative management of carotid endarterectomy multi-center clinical experience at home and abroad

Objective To summarize multi-center clinical experiences of surgical techniques and perioperative management of 3 226 cases of carotid endarterectomy (CEA) to treat extracranial carotid atherosclerotic stenosis.Methods Retrospective analysis to explore the operation plan and skill and summarize the key point of peri-operation management was performed for experience of 3 226 cases of CEA performed in multicenter during eight years from May 2005 to May 2013.Results All of 3 226 cases of CEA performed successfully.Among which,2 910 cases (90.2％) were EEA,and 316 cases (9.8％) were pCEA.The average carotid clamping time was (15.5 ± 2.0) min.The average operation time was (50.5 ± 5.0) min.There were 3 case of death after CEA,2 cases of cerebral infarction,ipsilateral cerebral hemorrhage in 1 case,28 cases of incision hematoma,1 case of patients with postoperative severe nerve mental symptoms and cognitive impairment,1 case of small jaw joint dislocation ; cranial nerve injury in 6 cases,including 4 cases of hypoglossal nerve injury,facial nerve mandible injury in 2 cases.There were no serious postoperative complications and death occurred in 81 patients with high-risk factors.Conclusions CEA is a safe and effective treatment to cure extracranial carotid atherosclerotic stenosis.Perfect perioperative management and principles of "4 S + 1 D" are the key to the success of the CEA.EEA is worth promoting because of its simplicity of operation,operation and blocking time is short,don't need shunt and patch,cost is low. Key words: Carotid atherosclerotic stenosis;  Carotid endarterectomy;  Eversion carotid endarterectomy;  Carotid endarterectomy with patch plasty;  Surgical techniques