Carotid endarterectomy in patients with territorial transient ischemic attacks.
Results are presented of a retrospective analysis of 651 carotid endarterectomies in 605 patients with carotid territorial transient ischemic attacks (TIAs). All operations were performed by the same surgeon in a community hospital from 1963 to 1986. Arteriographic findings consisted of carotid stenosis of 50% or greater in 88.5% of patients and stenosis less than 50% and/or an ulcerated plaque in the remaining 11.5%. Medical risk factors were detected in 92% of patients; hypertension, peripheral vascular disease, and coronary atherosclerosis were most prevalent. All operative procedures were conducted with the patients under general anesthesia, routine shunting, and arterial closure without a patch. The perioperative stroke rate was 1.5% (10 patients); the morality rate was 0.8% (three deaths from myocardial infarction and two from stroke) for a combined stroke and mortality rate of 2.0% (13 of 605 patients). Follow-up (mean 61.8 months) was possible in 570 (96%) of the patients surviving operation without a perioperative stroke. The cumulative probability of late stroke (i.e., cerebral infarct ipsilateral to the operated artery) was 2.5% at 5 years and 8.1% at 10 years. When the perioperative stroke-mortality rate (2.0%) is combined with the data for late ipsilateral stroke, the 5- and 10-year probabilities of ipsilateral stroke were 4.5% and 9.9%, respectively (mean 1% per year for 10-year period). Coronary atherosclerosis accounted for 43% of late deaths and 16% of strokes. The perioperative stroke-mortality rate of 2.0% in this group of patients falls within the acceptable range for carotid endarterectomy in patients with TIA.(ABSTRACT TRUNCATED AT 250 WORDS)
Nunn
D B
DB
Department of Surgery, St. Vincent's Medical Center, Jacksonville, FL.
D000368:Aged; D002339:Carotid Arteries / Q000601:surgery; D002340:Carotid Artery Diseases / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000401:mortality; D004691:Endarterectomy / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D012189:Retrospective Studies; D013997:Time Factors