[Carotid endarterectomy. Risks and benefits of treatment]

From 1980 to 1985, 210 endarterectomies of the carotid artery were performed in 187 patients (50 female, 127 male). In 55 cases there were asymptomatic filiform stenoses with concomitant high grade stenosis or occlusion of the contralateral artery. 155 stenoses of the carotid artery of mostly the highest degree were symptomatic. Patients were examined by means of the direct CW-doppler ultrasound immediately postoperatively and every six months up to six years. In 9 cases (4.3%) there was a perioperative (central) neurologic incident, which in 5 (2.3%) cases was followed by permanent neurologic deficits. Three of these incidents were caused by an early occlusion of the reconstruction. The stroke rate (including perioperative stroke rate) determined by life table analysis for the whole group after 6 years was 5.6%. The rate of TIA's was 4.5%. The rate of local recurrence (stenosis greater than 50% or occlusions) after six years was 15.3%. Except for the above mentioned early occlusions only one recurrent stenosis was symptomatic. We believe that asymptomatic, non multimorbid patients with doublesided high grade stenoses and symptomatic patients profit from an endarterectomy of the carotid artery, as long as the perioperative stroke rate and mortality do not exceed 3-4%.