title: Clinical outcomes of carotid endarterectomy in patients with carotid artery tandem lesions.
abstract: OBJECTIVE
  When carotid artery tandem lesions are present, the benefits of carotid endarterectomy (CEA) to reduce recurrent stroke remain uncertain. The present retrospective cohort study aimed to determine the clinical outcomes of CEA for carotid artery tandem stenosis that was diagnosed by contrast-enhanced magnetic resonance angiography.
  
  
  METHODS
  Six hundred forty-seven consecutive patients underwent CEA between January 2001 and December 2010. Tandem stenosis, defined as a significant carotid bifurcation stenosis and identifiable stenosis of ≥50% of any downstream distal cerebral artery, was identified in 92 patients (14.2%) by contrast-enhanced magnetic resonance angiography. Patients with and without tandem stenosis were compared in terms of CEA outcomes. The primary end point was the composite of any stroke, myocardial infarction, or death during the periprocedural period or ipsilateral stroke within 4 years after CEA.
  
  
  RESULTS
  Tandem stenosis did not associate with ipsilateral stroke during postoperative follow-up. The 2 groups did not differ in terms of estimated 4-year primary end point rates (8.7% versus 3.8%; P=0.07) or ipsilateral stroke-free (P=0.56), any stroke-free (P=0.89), or overall survival (P=0.41) rates.
  
  
  CONCLUSIONS
  After diagnosis by contrast-enhanced magnetic resonance angiography, patients with and without tandem stenosis had similar rates of stroke and death.
authors.affiliation: From the Departments of Surgery (Y.H., H.K., T.-W.K., Y.-P.C., G.-E.K.), Neurology (S.U.K., D.-W.K.), and Radiology (D.H.L.), University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea; and Department of Surgery (H.P.), Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Youngjin
authors.initials: Y
authors.lastname: Han
authors.affiliation: From the Departments of Surgery (Y.H., H.K., T.-W.K., Y.-P.C., G.-E.K.), Neurology (S.U.K., D.-W.K.), and Radiology (D.H.L.), University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea; and Department of Surgery (H.P.), Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Hojong
authors.initials: H
authors.lastname: Park
authors.affiliation: From the Departments of Surgery (Y.H., H.K., T.-W.K., Y.-P.C., G.-E.K.), Neurology (S.U.K., D.-W.K.), and Radiology (D.H.L.), University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea; and Department of Surgery (H.P.), Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Sun U
authors.initials: SU
authors.lastname: Kwon
authors.affiliation: From the Departments of Surgery (Y.H., H.K., T.-W.K., Y.-P.C., G.-E.K.), Neurology (S.U.K., D.-W.K.), and Radiology (D.H.L.), University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea; and Department of Surgery (H.P.), Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Dong-Wha
authors.initials: DW
authors.lastname: Kang
authors.affiliation: From the Departments of Surgery (Y.H., H.K., T.-W.K., Y.-P.C., G.-E.K.), Neurology (S.U.K., D.-W.K.), and Radiology (D.H.L.), University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea; and Department of Surgery (H.P.), Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Deok Hee
authors.initials: DH
authors.lastname: Lee
authors.affiliation: From the Departments of Surgery (Y.H., H.K., T.-W.K., Y.-P.C., G.-E.K.), Neurology (S.U.K., D.-W.K.), and Radiology (D.H.L.), University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea; and Department of Surgery (H.P.), Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Hyunwook
authors.initials: H
authors.lastname: Kwon
authors.affiliation: From the Departments of Surgery (Y.H., H.K., T.-W.K., Y.-P.C., G.-E.K.), Neurology (S.U.K., D.-W.K.), and Radiology (D.H.L.), University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea; and Department of Surgery (H.P.), Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kwon
authors.affiliation: From the Departments of Surgery (Y.H., H.K., T.-W.K., Y.-P.C., G.-E.K.), Neurology (S.U.K., D.-W.K.), and Radiology (D.H.L.), University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea; and Department of Surgery (H.P.), Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Yong-Pil
authors.initials: YP
authors.lastname: Cho
authors.affiliation: From the Departments of Surgery (Y.H., H.K., T.-W.K., Y.-P.C., G.-E.K.), Neurology (S.U.K., D.-W.K.), and Radiology (D.H.L.), University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea; and Department of Surgery (H.P.), Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Geun-Eun
authors.initials: GE
authors.lastname: Kim
mesh_terms: D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000401:mortality / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: carotid stenosis; endarterectomy, carotid; magnetic resonance angiography