Late stroke in patients after carotid endarterectomy.
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.
Chang
J B
JB
Long Island Vascular Center, Roslyn, New York 11576, USA.
Stein
T A
TA
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