Carotid endarterectomy: operative risks, recurrent stenosis, and long-term stroke rates in a modern series.
To determine whether carotid endarterectomy (CEA) safely and effectively maintained a durable reduction in stroke complications over an extended period, we reviewed our data on 478 consecutive patients who underwent 544 CEA's since 1976. Follow-up was complete in 83% of patients (mean 44 months). There were 7 early deaths (1.3%), only 1 stroke related (0.2%). Perioperative stroke rates (overall 2.9%) varied according to operative indications: asymptomatic, 1.4%; transient ischemic attacks (TIA)/amaurosis fugax (AF), 1.3%; nonhemispheric symptoms (NH), 4.9%; and prior stroke (CVA), 7.1%. Five and 10-year stroke-free rates were 96% and 92% in the asymptomatic group, 93% and 87% in the TIA/AF group, 92% and 92% in the NH group, and 80% and 73% in the CVA group. Late ipsilateral strokes occurred infrequently (8 patients, 1.7%). Late deaths were primarily cardiac related (51.3%). Stroke-free rates were significantly (p less than 0.0001) greater than stroke-free survival rates, confirming a non-stroke related cause for late death. Restenoses greater than 50% according to duplex scanning developed in 13%, most (67%) within 2 years after CEA. Most of these (77%) were asymptomatic, and only 0.3% (1 patient) presented with a permanent neurologic deficit. The results of carotid endarterectomy are superior to those of optimal medical management in symptomatic and asymptomatic patients in terms of long-term stroke prevention. When low perioperative stroke mortality/morbidity rates are achieved, carotid endarterectomy is justified for treatment of patients with carotid bifurcation disease.
Mattos
M A
MA
Department of Surgery, Southern Illinois University School of Medicine, Springfield.
Hodgson
K J
KJ
Londrey
G L
GL
Barkmeier
L D
LD
Ramsey
D E
DE
Garfield
M
M
Sumner
D S
DS
D001766:Blindness / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D016893:Carotid Stenosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D016894:Endarterectomy, Carotid / Q000401:mortality / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D015993:Life Tables; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate