Our purpose was to explore indications, preoperative investigation and operative technique for carotid endarterectomy in Norway.
A questionnaire was sent to 22 departments performing vascular surgery. Questions included an evaluation of the volume of carotid surgery, indications, preoperative examination, surgical technique and postoperative follow up. We requested the number of carotid endarterectomies performed in 2002, and whether the hospital also performed endovascular treatment for carotid artery stenosis.
Carotid endarterectomy was performed in 19 hospitals, with an average of 16 operations per department. Among the surgeons, 18 stated that the number of carotid endarterectomies in Norway was too low. Endovascular treatment was performed in three hospitals. There was agreement on the indications for carotid endarterectomy for symptomatic stenosis, while the practice for asymptomatic stenosis varied widely. Patients who had undergone a minor stroke, were offered surgery after more than 4 weeks in 10 cases. In 11 departments a neurologist always examined the patient preoperatively. Duplex ultrasound examination of the carotid arteries was usually done by a neurologist; only 6 departments did preoperative conventional angiography in all cases. More than half of the surgeons always used a shunt during the operation, while only a few used intraoperative monitoring. Nine out of 20 surgeons closed the arteriotomy with a patch.
Consensus regarding the indications for carotid endarterectomy should be sought and more patients probably be offered surgery soon after the occurrence of symptoms.