ABSTRACT
Until 1950, it was generally assumed that most ischemic, carotid territory strokes followed
in situ intracranial thrombosis, largely because the carotid arteries were used for embalming
and never subjected to autopsy examination. The pioneering work of Miller Fisher sub-
sequently showed the internal carotid artery (ICA) to be an important site for atherosclerosis
and secondary thromboembolism into the brain (1). In 1954, Eastcott et al. were credited with
having performed the first carotid endarterectomy (CEA; although it was actually a resection
with primary reanastomosis) in a patient with repeated transient ischemic attacks (TIA) (2).
However, the first CEA may have been performed by DeBakey one year earlier in 1953,
although this was not reported until 1975 (3). Over the next 50 years, CEA became the most
frequently performed vascular procedure in the Western world, but it would be fair to concede
that it has remained one of the most controversial and scrutinized procedures of all time.
