From the Guidelines
Otolaryngologists can perform carotid endarterectomies, but it is not a common practice for most ENT physicians, and the procedure typically requires specialized training beyond standard ENT residency. Carotid endarterectomy is a surgical procedure to remove plaque buildup from the carotid artery to prevent stroke, and it traditionally falls within the domain of vascular surgeons, neurosurgeons, and some general surgeons. However, some otolaryngologists, particularly those with additional training in head and neck surgery, may perform these procedures. This is more likely in academic medical centers or specialized practices where ENT surgeons have pursued fellowship training in vascular procedures of the head and neck. The anatomical expertise that otolaryngologists possess regarding the neck region provides them with relevant knowledge of the area, though the vascular surgical techniques required for carotid endarterectomy typically require specialized training beyond standard ENT residency.
According to a recent systematic review and meta-analysis 1, there is no conclusive evidence to restrict carotid endarterectomy to specific specialties, but the procedure should be performed by trained and experienced surgeons. The review highlights the importance of considering the patient's preoperative clinical status, the surgeon's experience, and the center's outcomes when deciding on the best course of treatment.
Patients requiring a carotid endarterectomy should inquire about their surgeon's specific training and experience with this procedure, regardless of their specialty designation. It is essential to consider the risks and benefits of the procedure, as well as the surgeon's expertise, to ensure the best possible outcome.
Some key points to consider when evaluating a surgeon's qualifications to perform carotid endarterectomy include:
- Their experience with the procedure
- Their training in vascular surgery
- The center's outcomes and complication rates
- The patient's individual risk factors and clinical status
By considering these factors and seeking out a qualified and experienced surgeon, patients can minimize their risk of complications and ensure the best possible outcome from their carotid endarterectomy procedure.
From the Research
Carotid Endarterectomy and Otolaryngologists
- Carotid endarterectomy is a surgical procedure typically performed by vascular surgeons or neurosurgeons to remove plaque buildup in the carotid arteries 2, 3, 4, 5, 6.
- The procedure's success and risk of complications depend on various factors, including the surgeon's experience and the patient's overall health 2, 3, 4, 5, 6.
- While otolaryngologists (ear, nose, and throat specialists) are skilled surgeons, carotid endarterectomy is not typically within their scope of practice 2, 3, 4, 5, 6.
Surgical Specialty and Carotid Endarterectomy
- Studies have examined the impact of surgical specialty on the outcomes of carotid endarterectomy, with some finding no significant differences between different specialties 4.
- However, other research emphasizes the importance of a skilled cerebrovascular surgeon with demonstrable morbidity and mortality rates below 3% 3.
- The availability of a skilled surgeon with experience in vascular principles and cerebral physiology is crucial for a technically acceptable carotid surgery 3.
Training and Experience
- The training and experience of the surgeon performing carotid endarterectomy are critical factors in determining the procedure's success and risk of complications 2, 3, 4, 5, 6.
- Surgeons who perform a higher volume of carotid endarterectomies tend to have better outcomes, with lower rates of postoperative stroke and mortality 2.