Carotid endarterectomy: operative risks, recurrent stenosis, and long-term stroke rates in a modern series

• Published in: Journal of cardiovascular surgery Vol. 33; no. 4; p. 387
• Main Authors: Mattos, M A, Hodgson, K J, Londrey, G L, Barkmeier, L D, Ramsey, D E, Garfield, M, Sumner, D S
• Format: Journal Article
• Language: English
• Published: Italy 01.07.1992
• Subjects: Blindness - epidemiology; Blindness - mortality; Blindness - prevention & control; Carotid Stenosis - epidemiology; Carotid Stenosis - mortality; Carotid Stenosis - surgery; Cerebrovascular Disorders - epidemiology; Cerebrovascular Disorders - mortality; Cerebrovascular Disorders - prevention & control; Endarterectomy, Carotid - mortality; Endarterectomy, Carotid - statistics & numerical data; Follow-Up Studies; Humans; Illinois - epidemiology; Incidence; Ischemic Attack, Transient - epidemiology; Ischemic Attack, Transient - mortality; Ischemic Attack, Transient - prevention & control; Life Tables; Prospective Studies; Recurrence; Retrospective Studies; Risk Factors; Survival Rate; Illinois
• ISSN: 0021-9509

To determine whether carotid endarterectomy (CEA) safely and effectively maintained a durable reduction in stroke complications over an extended period, we reviewed our data on 478 consecutive patients who underwent 544 CEA's since 1976. Follow-up was complete in 83% of patients (mean 44 months). There were 7 early deaths (1.3%), only 1 stroke related (0.2%). Perioperative stroke rates (overall 2.9%) varied according to operative indications: asymptomatic, 1.4%; transient ischemic attacks (TIA)/amaurosis fugax (AF), 1.3%; nonhemispheric symptoms (NH), 4.9%; and prior stroke (CVA), 7.1%. Five and 10-year stroke-free rates were 96% and 92% in the asymptomatic group, 93% and 87% in the TIA/AF group, 92% and 92% in the NH group, and 80% and 73% in the CVA group. Late ipsilateral strokes occurred infrequently (8 patients, 1.7%). Late deaths were primarily cardiac related (51.3%). Stroke-free rates were significantly (p less than 0.0001) greater than stroke-free survival rates, confirming a non-stroke related cause for late death. Restenoses greater than 50% according to duplex scanning developed in 13%, most (67%) within 2 years after CEA. Most of these (77%) were asymptomatic, and only 0.3% (1 patient) presented with a permanent neurologic deficit. The results of carotid endarterectomy are superior to those of optimal medical management in symptomatic and asymptomatic patients in terms of long-term stroke prevention. When low perioperative stroke mortality/morbidity rates are achieved, carotid endarterectomy is justified for treatment of patients with carotid bifurcation disease.