Stroke, Vol 15, 959-964, Copyright © 1984 by American Heart Association
A Muuronen
Between 1980 and 1982, 227 consecutive patients with transient ischemic
attack (TIA) or ischemic brain infarction (IBI) were evaluated as possible
candidates for carotid surgery in the Department of Neurology, University
of Helsinki. One hundred and ten patients (mean age 58, range 41-72 years)
were selected for surgery; 82 of them had had TIA and 28 IBI as the
presenting symptom. After a total of 128 operations (84 unilateral and 18
bilateral endarterectomies, and 8 arterial reconstructions), 16 patients
(14.5%) developed neurological deficits. In 7 patients (6.4%), the deficit
was severe and 4 of them (3.6%) died within the first four days after
surgery. Ten patients had occlusion of the contralateral internal carotid
artery and/or severe hypertension. Five of them suffered ischemic brain
infarction after the operation and two died. Operation on an occluded
internal carotid artery in 7 patients was complicated by hemiparesis in two
patients, one of whom died. Patients with surgical complications more often
had severe hypertension (p less than .001), total occlusion of the
contralateral internal carotid artery, (n.s.) and severe angiographic
changes (n.s.) compared with patients without complications. During the
follow-up the annual rate for IBI was 3.3% and for acute myocardial
infarction (AMI) 4.4%. Vascular death occurred with a frequency of 1.7% per
year. The results emphasize that patients with TIA or IBI should be
carefully evaluated before recommending surgical treatment for prevention
of threatened stroke. Patients with severe risk factors may fare better on
medical treatment than with surgical intervention.
ARTICLES
Outcome of surgical treatment of 110 patients with transient ischemic attack
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