Carotid Endarterectomy: Principles and Technique PDF

Preface to the Second Edition

It is a privilege to be able to write a second preface for a new edition of Carotid Endarterectomy: Principles and Technique, twelve years after I wrote the orginal one. As I had predicted in that first preface, the scientific and epidemiologic universe surrounding carotid artery surgery has changed dramatically—and for the better, for both surgeons and patients—during this time.

Of course I have moved on in the academic world since 1994, first to assume the Harry Wilkins Chair of Neurosurgery at the University of Oklahoma in 1997 and then in 2004 to become Professor and Chairman of the Department of Neurosurgery at Temple University in Philadelphia. Perhaps the only constant is my ongoing fascination with the scientific background and technical performance of carotid artery surgery. I have been fortunate to have outstanding neurology and vascular surgery colleagues at both of these institutions, as I had at Iowa when the first edition was published.

We know so much more now than we did in 1994 about the propriety of carotid reconstruction based on quality data from credible investigators around the world. For asymptomatic disease the ACST results have reinforced the strong data from ACAS, and validate a surgical option in stroke prevention for these patients. The NASCET data, the early iteration of which we discussed in the first edition, has been expanded to validate a surgical option for 50% or greater symptomatic stenosis, data which correlate well with ECST and VASST.

The endovascular universe has changed as well. Quality devices, with protected stenting, now offer a viable and seemingly enduring treatment option for patients with carotid disease who have co-morbidities that preclude a surgical approach. Data regarding equivalency of endovascular treatment for routine carotid patients do not yet exist, except perhaps for SAPPHIRE-studied high-risk patients, and I implore the reader to study that data carefully, as discussed in Chapter 1, and draw your own conclusions. Clearly there will be new high-quality cooperative trials comparing endovascular and surgical approaches, and thoughtful surgeons will need to study these data carefully, and potentially revise their practice patterns, if the data justify a change at some future time.

The reader will note that we have a new publisher. The publishing rights for Carotid Artery Surgery: Principles and Technique were sold to Marcel Dekker, Inc. several years ago, and as part of that transfer I agreed to begin work on this second edition. As time passed Marcel Dekker was absorbed into Informa Healthcare U.S.A., who have completed the task with me. They have proved to be wonderful partners, professional, organized, and efficient, and I hope the reader will find that this book justifies my confidence in them, and theirs in me. In particular, I am indebted to Geoff Greenwood in England, who made the initial contact and directed the project, Dana Bigelow in New York, who collated and assimilated all the new materials with me, and Joanne Jay at The Egerton Group Ltd., who took charge of production.

This book, then, represents twelve years additional experience on my part with carotid surgery. I have significantly expanded and updated the didactic material in Chapter 1, and I feel it is quite current. There are many more cases and interesting examples of anatomical variants, and an expanded section on complications. I retained much of the old material from the first edition, substituted a few new photographs when I thought they could be improved upon, but mostly added new material from the storehouse of clinical material that I have been accumulating in the intervening decade (plus).

As in the first edition I hope the readers find this information useful, educational, and valid, and that in some small way it advances our knowledge of carotid surgical philosophy and technique. I have been most gratified at the positive worldwide reception that was afforded to the first edition, and based on that it has been my privilege to train surgeons from many international centers who have come to visit and observe. It is my earnest hope that this current offering, which to my mind really offers much greater depth and experience, will prove to be useful to practicing surgeons as well.

Carotid surgery, performed by skilled surgeons with quantifiable results, prevents stroke in asymptomatic and symptomatic patients. The facts are unimpeachable. Our challenge now is to continually refine the techniques to ensure the greatest possible margins of safety, and to educate surgeons around the world to ensure uniform standards of care for all deserving patients.