Carotid endarterectomy in patients with intracranial vascular disease: short-term risk and long-term outcome.
To determine the influence of angiographically identifiable intracranial vascular lesions on the outcome of carotid endarterectomy, 597 patients from our carotid surgery registry who had had complete angiographic evaluation were divided into two groups: (1) significant intracranial disease identified by angiography (N = 134) and no significant intracranial disease identified by angiography (N = 463). The short- and long-term outcomes of carotid endarterectomy in the two groups were compared. Perioperative stroke morbidity (intracranial disease 1.9%, no intracranial disease 1.8%) and mortality (intracranial disease 0.5%, no intracranial disease 0.7%) were acceptable and not statistically different (p greater than 0.7). Late stroke prevention was nearly identical in the two groups, with 3-, 5-, and 10-year life-table of stroke-free rates of 93%, 87%, and 79%, respectively, versus 92%, 90%, and 85%, respectively, in the intracranial disease and no intracranial disease groups (p = 0.75). The incidence of recurrent transient ischemic attack was 9.7% in the intracranial disease group and 6.5% in the no intracranial disease group (p = 0.22). In the clinical population studied in the described method, angiographically identifiable intracranial vascular disease did not appear to have a statistically demonstrable influence on the short-term or long-term prognosis after carotid endarterectomy.
Mackey
W C
WC
New England Medical Center, Tufts University Department of Surgery, Boston, MA 02111.
O'Donnell
T F
TF
Callow
A D
AD
D002545:Brain Ischemia / Q000601:surgery; D002339:Carotid Arteries / Q000601:surgery*; D002423:Cause of Death; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004691:Endarterectomy / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate