Carotid artery surgery and the principle of prophylaxis: recurrence in operated and nonoperated patients.
A total of 700 carotid endarterectomies have been performed over a 24-year period at the authors' institute; of these patients 632 (90.3%) had unilateral and 68 (9.7%) had bilateral disease. Some 71 patients who declined operation were followed-up to obtain the natural history of carotid disease. The operative results were compared against this untreated group of patients. Surgical endarterectomy was recommended for a recovered stroke in 190 patients (27.1%), progressive ischaemia in 20 (2.9%) and transient ischaemic attacks in 410 (58.6%). A group of 100 patients with non-specific symptomatology, who were considered 'symptom-free', were also operated on; none of these died or developed permanent postoperative neurological defects. The mean age of patients was 56 (range 28-86) years. The overall operative mortality rate was 0.8%. Perioperative neurological deficits occurred in 0.5% and temporary cranial nerve injury in 1.8%. The follow-up covered a period of 10 years, but was in several instances extended to 14 years. The incidence of late neurological events in the patients having an endarterectomy was 3%. In the non-operated group, 12% of normotensive and 18% of hypertensive patients developed symptoms. The 10-year postoperative survival rate was 80% in the symptom-free group of patients, 70% in those with transient ischaemic attacks and 60% in those who had a previous stroke.
Poulias
G E
GE
Department of Thoracic and Cardiovascular Surgery, Red Cross General Hospital, Athens, Greece.
Doundoulakis
N
N
Skoutas
B
B
Haddad
H
H
Karkanias
G
G
Papadakis
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000209:etiology / Q000601:surgery; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D003324:Coronary Artery Disease / Q000503:physiopathology; D020209:Cranial Nerve Injuries; D018572:Disease-Free Survival; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010243:Paralysis / Q000209:etiology; D012008:Recurrence; D015996:Survival Rate