Vascular Surgery Patient Experiences Severe Stroke During Procedure

Carotid endarterectomy (CEA) is a procedure meant to reduce the risk of stroke long-term. That being said, there is an operative risk of about 2-3%.  Carotid disease is divided into symptomatic and asymptomatic.  Everyone agrees that CEA should be performed for symptomatic patients with >50% stenosis due to the fact that it decreases your 2 year stroke risk from 26 to 9%. However, there is no consensus for asymptomatic disease. Older studies show an absolute 5 year stroke risk reduction of 5% (from 10 to 5%). However, that was before statin medications. There is an ongoing trial called the CREST II trial which is meant to answer this question. Many believe that there is no benefit to surgery for asymptomatic disease UNLESS there is progression of stenosis despite maximal medical therapy, or there is echolucent plaque on ultrasound. From the synopsis about the case, it seems like this patient never should have had surgery (assuming he was asymptomatic and that he had only a moderate stenosis). I routinely perform carotid endarterectomies. I have not had a patient develop a stroke after a carotid endarterectomy, although I was involved in a similar case during training. I have both lectured and published on this topic. I am currently Associate Professor of Surgery at a major medical university as well as Fellowship program director in the division of Vascular Surgery and Endovascular surgery.