title: Late stroke in patients after carotid endarterectomy.
abstract: BACKGROUND
  Some patients may be more predisposed to develop an ulceration of atherosclerotic plaque in the carotid artery, and emboli. These patients should be more at risk for a late stroke even after carotid endarterectomy than patients who are not.
  
  
  METHODS
  Six-hundred thirty-eight patients had 750 carotid endarterectomies. Excised plaque specimens were examined for gross ulceration. The degree of stenosis was determined by duplex scan and/or angiography, and at operation. The median follow-up time was 3.6 years. The risk of a stroke occurring >30 days after carotid endarterectomy was calculated. Within 1 year, an endarterectomy of the contralateral artery was done in 77 patients (Subgroup) at a median time of 60 days.
  
  
  RESULTS
  Late stroke occurred in 48 patients. Patients who had had ulcerated plaque had a stroke at a median time of 2.0 years, and patients who had had no ulcers had a stroke at a median time of 5.2 years (P < 0.025). The 14-year stroke-free curve was lower (P < 0.05) if there was plaque ulceration. In the Subgroup, plaque ulcers were found in 55 patients (71%) at the first endarterectomy and later in 46 of the 55 patients (84%) in the contralateral artery. No ulcers were found in 22 patients (29%) initially, but later 50% had ulcers in the contralateral artery. The risk of an ulcer in the contralateral artery was increased (P < 0. 005) in those patients who had ipsilateral carotid ulcers.
  
  
  CONCLUSIONS
  Some patients appear to be predisposed for plaque ulceration and late stroke.
authors.affiliation: Long Island Vascular Center, Roslyn, New York 11576, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Chang
authors.forename: T A
authors.initials: TA
authors.lastname: Stein
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000209:etiology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012307:Risk Factors; D013997:Time Factors; D014456:Ulcer / Q000473:pathology