Stroke, Vol 18, 1005-1010, Copyright © 1987 by American Heart Association
GL Moneta, DC Taylor, SC Nicholls, RO Bergelin, RE Zierler, A Kazmers, AW Clowes and DE Strandness Jr
In a 4-year period, 129 asymptomatic high-grade (80-99%) internal carotid
artery stenoses were identified in 115 patients. Because we previously
demonstrated a strong relation between degree of carotid stenosis and
subsequent development of ipsilateral related events (stroke, transient
ischemic attack, and carotid occlusion), we changed our previous policy and
began to offer carotid endarterectomy to good surgical risk patients
referred to us with asymptomatic high-grade carotid stenosis. A total of 56
carotid endarterectomies were performed while 73 lesions were followed
nonoperatively. Operated and nonoperated groups were similar with regard to
age, prevalence of hypertension, cardiac disease, diabetes, and aspirin
use. Life table analysis to 24 months revealed a higher rate of stroke (19
vs. 4%, p = 0.08), transient focal neurologic deficits (28 vs. 5%, p =
0.008), and carotid occlusion (29 vs. 0%, p = 0.003) in the nonoperated
group. Eight of the 9 strokes in the nonoperated group occurred within 9
months of diagnosis of the high-grade lesion; none were preceded by a
transient ischemic attack. There was 1 perioperative stroke (1.8%) but no
in- hospital operative deaths and no difference in the late death rates of
the two groups. This suggests that the preservation of neurologic status in
patients with asymptomatic high-grade internal carotid artery stenosis can
be improved by carotid endarterectomy.
ARTICLES
Operative versus nonoperative management of asymptomatic high-grade internal carotid artery stenosis: improved results with endarterectomy
Department of Surgery, University of Washington, Seattle 98195.
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