[Anatomoclinical study of carotid artery stenosis. Effects on surgical indications]

Between January 1986 and November 1987, 156 carotid endarterectomies for atheromatous stenosis of the carotid bifurcation were performed in 137 patients; 118 were unilateral and 19 were bilateral. The lesions were asymptomatic in 47 cases and symptomatic in 109 cases. Contralateral carotid stenosis was observed in 66 patients and cerebral infarction was noted on preoperative CT scans in 34 patients. A morphological study of operative atheromatous carotid specimens divided the lesions into non complicated plaques (n = 40) and complicated plaques (n = 116), the complications being intraplaque haemorrhage (n = 64), intraluminal thrombus (n = 29) and rupture of the intima (n = 72). Intima rupture was observed in 64 per cent of asymptomatic lesions and 76 per cent of lesions with cerebral infarction (P = 0.04). Intraplaque haemorrhage was observed in 50 per cent of symptomatic lesions (P = 0.0001), and 86 per cent of lesions with intraplaque haemorrhage were symptomatic. These results confirm the embolic, but often asymptomatic, character of intima ruptures and the correlation between intraplaque haemorrhage and preoperative neurological symptoms. Our findings are in favour of a haemodynamic rather than embolic mechanism of the neurological symptoms associated with carotid stenosis. They also enable potentially dangerous and therefore surgical lesions to be determined.