Reconstructive Surgery of the Extracranial Arteries

  • R. Schmid-Elsaesser
  • R. J. Medele
  • H.-J. Steiger
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 26)


The first carotid endarterectomy (CEA) is usually accredited to Eastcott who reported in 1954 the successful incision of a diseased carotid bulb with end-to-end anastomosis of the internal carotid artery (ICA) to the common carotid artery (CCA). During the following years surgeons were quick to adopt and improve the intuitively attractive procedure. But by the early to mid 1980s several leading neurologists began to question the growing number of CEAs performed at that time. Six major CEA trials were then designed which are now completed or nearing completion. Most conclusive data are available from the North American Symptomatic Carotid Endarterectomy Trial (NASCET) for symptomatic carotid disease, and from the Asymptomatic Carotid Atherosclerosis Study (ACAS) for asymptomatic carotid disease. The key result of these studies is that CEA is beneficial to high grade symptomatic and asymptomatic carotid stenosis. While the benefit in symptomatic disease is clear, it may be negligible in asymptomatic patients suffering from other medical conditions, the most important being coronary artery disease. Since the conclusions from the different studies vary significantly, guidelines and recommendations with regard to CEA have been issued by a number of interest groups, so-called consensus conferences. The best known guidelines are published by the American Heart Association (AHA).


Internal Carotid Artery Carotid Endarterectomy Carotid Stenosis Carotid Artery Stenosis Asymptomatic Carotid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag/Wien 2000

Authors and Affiliations

  • R. Schmid-Elsaesser
    • 1
  • R. J. Medele
    • 1
  • H.-J. Steiger
    • 1
  1. 1.Department of Neurosurgery, Klinikum GroßhadernLudwig-Maximilians-UniversitätMunichGermany

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