Carotid endarterectomy in Iraq: a single-center experience

Background: Carotid endarterectomy (CEA) refers to surgical removal of carotid atheroma. It was first reported in 1956 and eventually became widely accepted as an effective operation for stroke prevention. Herein, we present the experience of a single Iraqi center in CEA. Patients and methods: We conducted a retrospective study of 21 patients with significant symptomatic carotid stenosis that was surgically managed in Ibn-Alnafees Hospital, Baghdad, over the period 2009–2014. Workup consisted of duplex ultrasonography and computed tomography angiography of the carotid arteries. General anesthesia, a standard technique, and routine carotid shunts were used, followed by patch closure, mostly a venous patch. Aspirin and antiplatelets were given postoperatively to patients who underwent a venous patch; otherwise, warfarin was prescribed. Results: There were 20 male patients. Ages ranged between 37 and 82 years, with a mean of 60.3 ± 12.2 years. One-third of the patients (n = 7) were in the seventh decade. Six of 12 patients had jobs consistent with a low economic status. Smoking, hypertension, and diabetes mellitus were the main risk factors. Most patients had hemiparesis (n = 17, 81%). All patients had significant carotid stenosis (moderate to severe). Twenty-two operations were performed (one patient underwent two operations). Left-sided operations were more frequent (14/8) (P 0.05), as well as venous patches (20/2 Gore-Tex) (P 0.05). There was no incidence of stroke, but cervical hematomas (n = 22), tongue deviation (n = 2), and hyperperfusion syndrome (n = 2) were seen, all of which resolved spontaneously; one case of mortality was reported (4.8%), in a 73-year-old-man. Conclusion: Although this study is the first on CEA in Iraq with a small number of patients, the results compare favorably with the published literature.