Comparison of the need for bypass shunt after stroke or transient ischemic attack in 97 patients

Using local anesthesia, we did 97 carotid endarterectomies--48 of them for acute completed stroke, stroke in evolution, or stroke associated with unstable neurologic status, and 49 for transient cerebral ischemic attack. The neurologic status of the awake patients was monitored continuously. Neurologic deterioration resulting from clamping of carotid circulation, and immediate recovery upon release of the clamp indicated need for a bypass shunt. Eighteen of the 48 patients who had had stroke and six of the 49 who had had a transient ischemic attack needed a bypass shunt. The difference was statistically significant (P less than .01).