What type of surgeon performs a carotid endarterectomy?

From the Guidelines

A vascular surgeon is the most appropriate specialist to perform a carotid endarterectomy, as they have specific expertise in blood vessel surgery and are associated with lower risks of stroke and death compared to other specialists. This surgical procedure is done to remove plaque buildup from the carotid arteries in the neck to prevent stroke. According to a recent systematic review and meta-analysis 1, vascular surgeons have a lower unadjusted risk of stroke and death compared to neurosurgeons and general surgeons. The European vascular surgery guidelines also recommend that carotid endarterectomy should be performed only by trained vascular surgeons 1.

Key Points to Consider

• Vascular surgeons have specific expertise in blood vessel surgery, making them the primary specialists for carotid endarterectomy.
• Neurosurgeons may also perform carotid endarterectomies, particularly in complex cases involving the brain's blood supply, but are associated with higher risks of stroke and death compared to vascular surgeons 1.
• General surgeons with specialized training may sometimes perform this operation, but vascular surgeons are still the preferred choice due to their specialized expertise.
• The procedure requires detailed knowledge of vascular anatomy and surgical techniques to safely remove plaque while maintaining blood flow to the brain.
• Patients requiring this surgery are typically referred to a vascular surgeon by their primary care physician or neurologist after being diagnosed with significant carotid artery stenosis through imaging studies like ultrasound, CT angiography, or MRI.

Recommendations for Practice

• Carotid endarterectomy should be performed by a specialist surgeon with low rates of perioperative mortality/morbidity, preferably a vascular surgeon 1.
• Eligible patients should undergo carotid endarterectomy as soon as possible after the event, ideally within 2 weeks 1.
• Carotid endarterectomy should only be performed at centers where outcomes of carotid surgery are routinely audited 1.

From the Research

Type of Surgeon Performing Carotid Endarterectomy

The type of surgeon who performs a carotid endarterectomy can vary. Key points to consider include:

• Carotid endarterectomy is performed by both vascular surgeons and neurosurgeons in the UK 2.
• General surgery residents can be trained in the performance of carotid endarterectomy using regional block anesthesia in awake patients without compromising patient safety 3.
• Vascular surgeons, cardiothoracic surgeons, general surgeons, and neurosurgeons all perform this procedure, with varying outcomes 4.

Surgical Specialties and Outcomes

Outcomes for carotid endarterectomy can differ based on the surgeon's specialty:

• Patients treated by vascular surgeons had significantly fewer strokes and a lower re-occlusion rate at 5 years compared to patients of general surgeons 4.
• Vascular surgeons also had significantly shorter hospital stays but higher charges relative to general surgeons 4.
• Trainee vascular surgeons can perform carotid endarterectomy safely when assisted and supervised by a specialist vascular surgeon, although they may have longer operating times and higher rates of peripheral nerve complications 5.

Training and Supervision

The role of training and supervision in carotid endarterectomy is crucial:

• Supervised training of general surgery residents in carotid endarterectomy performed on awake patients under regional block is safe and desirable 3.
• Carotid endarterectomy can be performed safely by a trainee vascular surgeon when assisted and supervised by a specialist vascular surgeon 5.