Carotid endarterectomy after reversible ischemic neurologic deficit or stroke: is it of value?
The benefit of carotid endarterectomy (CE) in preventing recurrent stroke and improving survival in the patient who has sustained a reversible ischemic neurologic deficit (RIND) or stroke is still controversial. To determine the long-term benefits and value of CE in these patients, a 10-year review of 253 patients who suffered a RIND or stroke was conducted. All patients had CT brain scans, as well as arch, extracranial, and intracranial arteriography; any patients without demonstrated carotid bifurcation disease were excluded from the study. On the basis of clinical symptoms and CT scan findings, 66 patients were categorized as having sustained a RIND and 187 a stroke. One hundred fifty-one patients who suffered a RIND or stroke had CE, whereas 102 patients with RIND or stroke did not have CE and served as a control group. All endarterectomies were performed with a temporary indwelling shunt. Postoperative complications included two deaths (1%), six strokes (4%), and 10 transient neurologic deficits (7%). In follow-up extending to 10 years the cumulative incidence of recurrent stroke was only 7% (11 patients) in the operated group, whereas 18% of patients in the nonoperated control group (18) sustained a recurrent stroke (p less than 0.05). As anticipated, the leading cause of death during follow-up was cardiac related; although CE did not significantly improve long-term survival, there was more than a twofold decrease in the incidence of recurrent stroke as a cause of death in the group having CE.(ABSTRACT TRUNCATED AT 250 WORDS)
Rosenthal
D
D
Department of Vascular Surgery, Georgia Baptist Medical Center--Medical College of Georgia, Atlanta.
Borrero
E
E
Clark
M D
MD
Lamis
P A
PA
Daniel
W W
WW
D000206:Actuarial Analysis; D000465:Algorithms; D002545:Brain Ischemia / Q000401:mortality / Q000601:surgery*; D002339:Carotid Arteries / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000401:mortality / Q000517:prevention & control / Q000601:surgery*; D004691:Endarterectomy; D005500:Follow-Up Studies; D006801:Humans; D012008:Recurrence; D013997:Time Factors