ABSTRACT

Carotid endarterectomy was introduced in the 1950s and became popular in the 1970s and early 1980s, but it was not until 1991 that it was shown to be of value in patients with a recently symptomatic 70-99% carotid stenosis (24,25). However, the history of carotid artery surgery goes back much further. The first operations on the carotid artery were ligation procedures for trauma or hemorrhage. The first report was in Benjamin Bell’s surgery in 1793 (26). However, most early ligations resulted in the death of the patient. The first successful ligation was performed by a British naval surgeon, David Fleming, in 1803 (27). This operation was performed for late carotid rupture following neck trauma in an attempted suicide. The first successful ligation for carotid aneurysm was performed five years later in London by Astley Cooper (28). By 1868, Pilz was able to collect 600 recorded cases of carotid ligation for cervical aneurysm or hemorrhage with an overall mortality of 43% (29). In 1878, an American surgeon named John Wyeth reported a 41% mortality in a collected study of 898 common carotid ligations, and contrasted this with a 4.5% mortality for ligation of the external carotid artery (30).