Long-Term Results of Endarterectomy of the Internal Carotid Artery for Cerebral Ischemia and Infarction

Abstract

The immediate and long-term results of carotid endarterectomy for treatment of acute cerebral ischemia or infarction were studied in 95 patients who were observed for an average period of 40 months after the surgical procedure. The operation resulted in death for 12 patients and worsening of the neurological deficit in six others. During the follow-up period, there were 22 additional deaths, most of which were caused by myocardial infarction or other complications of systemic atherosclerotic vascular disease. The significant factors adversely affecting the prognosis of these patients consisted of severe electrocardiographic abnormalities, the presence of bilateral carotid occlusive lesions, cerebral infarction prior to endarterectomy, and the age of the patient. Following endarterectomy only five patients were observed to have recurrent attacks of transient cerebral ischemia which were few in number and stopped spontaneously. Recurrent cerebral infarction developed in only seven patients, six of whom had unsuccessful or incomplete removal of the carotid occlusive lesions. Although this low incidence of recurrent ischemia and infarction seems to be evidence for the therapeutic value of carotid endarterectomy, further observations on a comparable group of patients treated nonsurgically are needed to support this conclusion.