[Treatment of patients with atherosclerotic carotid stenosis in 1993. Indications and long-term results of surgery].
Cerebrovascular accidents (CVAs) are the third commonest cause of death in France. Approximately 15% of them are due to stenosis of the extracranial internal carotid. The fact that a third of CVAs are followed by death and another third by major handicaps leads to the need for careful prevention. This has three aspects: 1) Correction of risk factors: hypertension, smoking, hyperglycemia, hyperlipidemia, obesity, alcohol abuse, hematological abnormalities and oral contraception; 2) the prescription of one of two platelet anti-aggregants, the efficacy of which has been proved: acetylsalicylic acid or ticlopidine; 3) surgical elimination of tight carotid stenoses. The following require surgery: 1) more than 70% stenosis following cerebral or ocular TIA or minor CVA; 2) more than 75% stenosis in asymptomatic patients or with episodes of VBI as well as 70% in case of thrombosis of the contralateral internal carotid; 3) following a CVA leaving serious sequelae: tight stenosis when it is reasonable to assume that a further CVA could lead to clinical worsening or to a loss of independence; 4) symptomatic and/or more than 80% restenosis. The decision should be made only after confirmation of the diagnosis and of the degree of stenosis and verification of the absence of any local or systemic contra-indication. The surgical team must have a low cumulative mortality and perioperative CVA rate. These patients require ongoing medical monitoring, particularly from a cardiological standpoint.
Mellière
D
D
Service de Chirurgie vasculaire, Hôpital Henri-Mondor, Créteil.
Césaro
P
P
Texier
J P
JP
Becquemin
J P
JP
D001161:Arteriosclerosis / Q000517:prevention & control / Q000601:surgery / Q000628:therapy*; D016893:Carotid Stenosis / Q000517:prevention & control / Q000601:surgery / Q000628:therapy*; D006801:Humans; D012307:Risk Factors; D013997:Time Factors
Le traitement des patients porteurs de sténoses carotidiennes athéromateuses en 1993. Indications et résultats à long terme de la chirurgie.