Surgical treatment of cerebrovascular occlusive disease. A follow-up study.
This prospective open study of 124 patients [80% with completed stroke (CS), 16% with TIAS, 4% with PRIND] consecutively admitted between 1976 and 1981 investigates the rates of reinfarction after surgical treatment (extra-intracranial arterial bypass, EIAB and/or carotid thrombendarterectomy, TEA). 34% of patients had unilateral carotid stenosis, 26% unilateral internal carotid artery occlusion, 17% had occlusion of one and stenosis of the contralateral internal carotid artery, 14% bilateral carotid stenosis. Combined surgical morbidity and mortality was 5% after 158 operations in 124 patients; 7 of the 8 complications occurred in patients with CS. Of the 120 survivors in the immediate postoperative period, after a mean follow-up period of 5.7 years ranging from 3-8 years, an infarct occurred in 5.8%, i.e., 1% per year; 3 of them occurred ipsilaterally, 2 contralaterally to the first infarct, two remained unknown. Among all 99 patients with CS, the reinfarction rate was 5% (1% per year); in CS patients with a minimal follow-up of 5 years, the annual reinfarction rate was 2%. Of fifty-three patients with completed stroke after EIAB with a mean follow-up of 4.6 years, 3.8% suffered reinfarction (0.8% per year). Among 26 patients with CS and unilateral carotid occlusion after a mean follow-up of 4.7 years, the reinfarction rate was 3.9% (0.8% per year). Among 46 patients with carotid occlusion with or without further stenotic or occlusive lesions, the reinfarction rate was 2.2%.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D000368:Aged; D002340:Carotid Artery Diseases / Q000601:surgery; D002343:Carotid Artery, Internal / Q000601:surgery; D002544:Cerebral Infarction / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000601:surgery*; D002546:Ischemic Attack, Transient / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012008:Recurrence