Comparative risk of operation and expectant management for carotid artery disease.

Publisher Website
Google Scholar
Abstract
Patients who undergo successful carotid endarterectomy without permanent neurologic morbidity have a significantly decreased risk of stroke compared to similar patients managed medically; the decision to recommend surgery remains controversial for the clinician. This controversy is based on the variability of surgical results. The average incidence of perioperative stroke and death is 9.1% but the surgical results show a range in permanent neurologic morbidity of 0.8-27% and in surgical mortality of 0-11.2%. The vascular surgery registry at the San Francisco VA Hospital, 1967-1975, lists 147 patients who underwent 186 carotid endarterectomies. Since 1971 there were 113 carotid endarterectomies in 92 patients with no deaths (0%), 1 stroke (0.9%) and 1 transient ischemic attack (0.9%). The surgical variability is due, in part, to patient selection, preoperative neurologic status, changes in surgical techniques with time and improvements in anesthesia for carotid surgery. The data give pause when weighing therapeutic alternatives for individual patients. Depending on the surgical series selected as a basis of comparison, results can justify either surgical or nonsurgical therapy. In the appropriate setting, carotid endarterectomy apparently can significantly reduce the risk of permanent neurologic deficit or mortality as compared to medical management. Surgeon and/or institution should be carefully selected before recommending surgery for patients with symptoms of extracranial vascular occlusive disease.

This publication has 17 references indexed in Scilit: