Quality control for carotid endarterectomy

The aims of this study are to assess whether the introduction of a rigorous quality control method could produce a sustained reduction in the intraoperative stroke rate in this unit and whether it was feasible and practical to implement such a programme. The second part of this study will assess the incidence of sustained embolisation in the early post-operative period and investigate whether the antiplatelet agent Dextran 40 can help stop this embolisation, potentially preventing carotid artery thrombosis.;A prospective audit of all patients undergoing carotid endarterectomy was performed. The ability to monitor intraoperatively with TCD and perform completion angioscopy was assessed, as was the impact that these quality control techniques had on influencing the surgery. Patients were monitored postoperatively with TCD and any patient who developed sustained embolisation was commenced on an infusion of Dextran 40.;91% had continuous intraoperative TCD monitoring and 94% underwent successful completion angioscopy, a technical error was identified in 5% of angioscopic assessments. The intraoperative stroke rate was 0% during this study. Postoperative monitoring revealed that 5% of patients develop significant embolisation following CEA, Dextran 40 appeared to stop this embolisation. The overall 30-day stroke or death rate following CEA has fallen from 6% prior to 1992 to 2.2% in 1998.;It is possible to implement a quality control programme for CEA and this has been associated with a fall in the overall 30-day death and any stroke rate.