Observations on cerebral computed tomography in patients having carotid endarterectomy

A review was undertaken of all patients seen in our institution between January 1978 and March 1987 in whom a cerebral CT scan was obtained in association with elective carotid endarterectomy. Three hundred fifty-nine such patients were identified. In a subgroup of 89 patients who were neurologically normal after carotid endarterectomy, scans were performed at least 48 hours after surgery to quantitate the incidence of silent postoperative infarction. These scans were interpreted by one neuroradiologist. Preoperative cerebral CT scans showed ipsilateral infarction in 146 of 359 patients (40.6%). Ipsilateral infarction was most common in patients with stroke (76%) but was also seen in 32.8% of patients with transient ischemic attacks, in 9 of 40 patients (22.5%) with nonhemispheric symptoms, and in 9 of 45 patients (20%) with asymptomatic hemodynamically significant carotid stenosis. The postoperative stroke rate was not significantly increased by the presence of infarct on preoperative cerebral CT scan (2.6% vs 1.9%). New infarcts were seen on cerebral CT scanning after carotid endarterectomy in 2 of 89 patients with no detectable neurologic abnormality (2.3%). This study demonstrates a high frequency of ipsilateral infarction in patients having elective carotid endarterectomy, even in those patients with clinical symptom complexes thought by many physicians to be relatively benign (i.e., transient cerebral ischemia, nonhemispheric ischemia, and asymptomatic carotid stenoses).(ABSTRACT TRUNCATED AT 250 WORDS)