Prospective study of the effectiveness and durability of carotid endarterectomy.
In a series of 252 consecutive patients who underwent 282 carotid endarterectomies, we conducted clinical and angiographic follow-up for 2 to 6 years (mean, 3.2 years). Digital subtraction angiography (DSA) was done postoperatively in 95% of cases. Clinical follow-up was achieved in 97% of cases, and DSA follow-up was obtained in 66% of cases. The overall group had a 1% operative minor morbidity (three cases of minimal new neurologic deficit), no major morbidity, and a 0.7% mortality (one death from stroke and one from myocardial infarction). Complications correlated well with the patient's preoperative risk category. During follow-up, 10 minor strokes, only 1 of which was attributable to the reconstructed artery, and 10 transient ischemic attacks, 3 of which were presumably related to recurrent stenosis, occurred. Asymptomatic mild to moderate restenosis of the internal carotid or common carotid artery was identified in 10% of follow-up DSAs and severe stenosis or occlusion in 3%. Stenosis in the opposite common carotid or internal carotid artery progressed in 48 cases (26% of follow-up DSAs and ultrasound studies), and 10 of these became symptomatic. An actuarial analysis of patients who had endarterectomy indicated that the cumulative probability of ipsilateral stroke was 1.5% at 1 month and 2% at 5 years. The cumulative probability of ipsilateral stroke, transient ischemic attack, or reversible ischemic neurologic deficit was 4% at 1 month and 8% at 5 years or less than 1% per year after the first month, with censoring at the time of the second surgical procedure.
Sundt
T M
TM
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905.
Whisnant
J P
JP
Houser
O W
OW
Fode
N C
NC
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality; D004691:Endarterectomy / Q000009:adverse effects / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors