[Surgical and endoluminal treatment of carotid stenosis: our experience]

Carotid endarterectomy and percutaneous transluminal angioplasty are known to prevent cerebrovascular accidents. From January 1997 to December 2002, 47 patients (35 male, 12 female; median age: 65 years) with carotid stenosis were observed. Neurological accidents were reported in 89.4%, while the other 10.6% were asymptomatic. The operative indications for the asymptomatic patients were high-degree stenosis (> 70%) of the internal carotid artery and ulcerated plaques with a moderate degree of stenosis (50%). Preoperative investigations consisted in colour Doppler ultrasonography, arteriography and cerebral CT scans or NMR. Endarterectomy was performed in 35 patients, while the other 12 underwent percutaneous transluminal angioplasty. The operative mortality in the 35 patients undergoing surgery was 5.7% (2 cases) and perioperative strokes occurred in 3 cases (8.6%). After 36 months, 32/35 patients (91.4%) were stroke-free, and one patient died as a result of a stroke. In the group of patients undergoing angioplasty, re-stenosis occurred in 2 cases (16.7%). Our results suggest that colour Doppler ultrasonography is a reliable examination for investigating the carotid axis and that both carotid endarterectomy and percutaneous transluminal angioplasty are safe procedures capable of preventing future cerebrovascular accidents.