title: Clinical characteristics and outcomes in carotid endarterectomy for internal carotid artery stenosis in a Japanese population: 10-year microsurgical experience.
abstract: Few studies have explored the significance of carotid endarterectomy (CEA) in long-term prognosis in Japanese patients. In the present study, we precisely elucidated the demographic and radiologic data, surgical morbidity and mortality, and long-term outcome in 135 Japanese patients who underwent a total of 142 CEAs due to 70%-99% stenosis of the internal carotid artery at our hospitals over a 10-year period. The prevalence of risk factors was similar to those found in previous studies in Western countries. Surgical mortality (0.7%) and morbidity (2.8%) were relatively low. Blood flow studies done immediately after CEA revealed postoperative hyperperfusion in 8 patients (5.6%), but none of these patients exhibited related symptoms. Over the mean follow-up period of 38.7 months, a total of 9 patients died (6.7%), due mainly to malignancies. Cerebrovascular events occurred in 12 patients (8.5%), including ipsilateral ischemic stroke in 2 (1.4%). In addition, 11 patients (8.2%) developed vascular disorders in other organs, including coronary artery disease and chronic renal failure. Follow-up radiologic examination revealed restenosis of >50% in 3 carotid arteries (2.1%). Stenosis of the contralateral carotid arteries progressed to >70% in 12 patients (9.2%). This study strongly suggests that microsurgical CEA is feasible and effective in preventing subsequent ipsilateral ischemic stroke in Japanese patients; however, long-term medical and radiologic surveillance is essential to reduce the incidence of ischemic stroke in other areas and of vascular disorders in other organs to improve prognosis.
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address: skuroda@med.hokudai.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakayama
authors.affiliation: Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hokari
authors.affiliation: Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yasuda
authors.affiliation: Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan.
authors.forename: Hisatoshi
authors.initials: H
authors.lastname: Saito
authors.affiliation: Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Iwasaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008137:Longitudinal Studies; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D010975:Platelet Aggregation Inhibitors