Carotid artery surgery in extracranial occlusive disease and cerebral ischemia. Early and late results.

Abstract

Carotid artery surgery became an established procedure for the treatment of cerebrovascular insufficiency associated with carotid artery stenosis and for the prevention of Stroke. 180 patients were consecutively treated because of occlusive disease of the carotid arteries: 152 (84%) had TIA's or reversible deficits, 11 (6.1%) had strokes with partial recovery, 16 (8.8%) asymptomatic carotid disease and 1 patient (0.5%) had global cerebral ischemia. The severity of occlusive disease was assessed by ECHO-DOPPLER, with or without colour mapping and by angiography: 21 had minimal lesions (less than 20%), 58 stenosis between 21-75%, 92 stenosis between 76-99% and 7 had complete occlusion of the carotid artery; 2 patients had aneurysmal disease 196 operations were performed; early mortality (less than 30 days) was 2.2% (4/180) and neurological morbidity 1.6% (3/180), the operative risk being 3.8%. Longterm results were assessed during a follow-up period extending to 132 months and were assessed by life-table analysis. Survival was 52.5%, 79.3% of the patients were fully asymptomatic during the follow-up but 89.2% were stroke-free, the incidence of stroke being 0.97%/year. These results compare favorably with data available from the natural history and confirm the efficacy of carotid artery reconstructive surgery for the prevention of stroke.