|Year : 2021 | Volume
| Issue : 3 | Page : 238-239
Carotid artery diseases and endarterectomy: Historical milestones
Srujal N Shah
Department of Vascular Surgery, Indovasc Hospital, Ahmedabad, Gujarat, India
|Date of Submission||16-May-2021|
|Date of Acceptance||18-May-2021|
|Date of Web Publication||6-Jul-2021|
Srujal N Shah
Department of Vascular Surgery, Indovasc Hospital, Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shah SN. Carotid artery diseases and endarterectomy: Historical milestones. Indian J Vasc Endovasc Surg 2021;8:238-9
Current understanding of carotid artery disease begins in ancient Greece. The term carotid is derived from the ancient Greek word “karos “ (κάρος), meaning to stupefy. This first description is ascribed to Hippocrates (460-370 BC) but better defined in the later accounts of Rufus (AD 100), who stated that the term was used because superficial compression of the vessels was known to induce stupefaction. Hippocrates proposed that “unaccustomed attacks of numbness and anesthesia” (the first description of transient ischemic attacks) precede and may predict oncoming apoplexy.
Swiss pathologist Wepfer (AD 1620-1695) postulated that interruption of blood supply to the brain was the cause of apoplexy. In his Historiae Apoplecticorum (1658), he described four cases of apoplexy that at autopsy were found to have occlusive thrombus in the carotid artery. His contemporary Willis (AD 1621–1675) published 6 years after the text of Wepfer, linking the function with structure and coined the term “neurology.” He described the circulus arteriosus cerebri and confirmed that a person may not die of apoplexy due to the circle of Willis.
Then came the era of carotid surgery. The first mention of carotid artery surgery occurred in 1973 by Hebenstreit for ligating the artery, for injury. However, the first deliberate ligation of the carotid artery occurred in 1798 by John Abernathy for a torn carotid artery. In 1808, Sir Astley Cooper performed the first successful cervical carotid ligation for a carotid aneurysm.
Chiary (AD 1851–1916) brought some brilliant observations that thromboembolic events and ulcerated plaque lead to cerebral infarction. However, the actual birth of the new era occurred when the genius neurologist Miller Fisher (AD 1913–2012) published his landmark articles and brought major attention to carotid pathology by doing arteriographies. He suggested the possibility that surgical intervention upon the carotid bifurcation might be an effective therapeutic modality in stroke prevention, indirectly stimulating one or more enterprising surgeons to take up the challenge and attempt to deal the lesion surgically. His prophetic words were acted upon by three different teams.
There is no dispute that the first successful carotid artery reconstruction for occlusive disease took place in Buenos Aires in 1951. Neurosurgeon Raul Carrea et al. admitted a 41-year-old man with aphasia, partially resected the diseased portion of the internal carotid artery and re-established flow through an external carotid to distal internal carotid artery anastomosis.
Authorship of the first carotid endarterectomy has been less clear because of a decades-long rivalry between two pioneering cardiac and vascular surgeons: Denton Cooley and Michael DeBakey. DeBakey claimed that he performed the first carotid endarterectomy in August 1953; however, he did not report the case until 1975 as it was his practice to acquire sufficient clinical data before rushing into print [Figure 1].
The first presentation of carotid reconstruction for carotid occlusive disease and TIA is attributed to Eastcott et al. in 1954 where he resected the diseased ICA and did direct anastomosis between ICA and CCA. This was in fact the beginning of exploration of carotid artery reconstruction as a primary procedure for carotid artery occlusive disease [Figure 2].
The long debate of the first successful CEA came to an end in November 2001 when Debakey showed all the proof, operative notes and records of lectures taken, and finally, Cooley also accepted the same. Debakey was awarded the lifetime achievement award by the Denton Cooley cardiovascular surgical society by Cooley himself and they remained friends, thereafter.
Carotid endarterectomy, arguably the most elegant and enjoyable operation, has been a source of great satisfaction to all vascular surgeons and has stood the test of time even in the modern era of endovascular intervention for preventing a stroke in a well-chosen patient.
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Conflicts of interest
There are no conflicts of interest.Address for correspondence: Dr. Srujal N Shah,
[Figure 1], [Figure 2]