Late results after carotid endarterectomy for amaurosis fugax

Amaurosis fugax is considered an ocular transient ischemic attack with an ominous prognosis. One hundred twenty-eight patients with amaurosis fugax as the presenting symptom underwent carotid endarterectomy at the University of California, San Diego (UCSD) and Scripps Clinic between 1970 and 1985 with one death (0.8%) and one postoperative permanent stroke (0.8%). Subsequently, these patients were followed up for 6 to 160 months (mean 45.3 months). Only two subsequent late strokes were documented (at 2 and 5 years after operation). These results were significantly better (p less than 0.01) by life-table analysis than the late stroke rate after carotid endarterectomy performed to treat anterior motor transient ischemic attacks at both UCSD and Scripps Clinic, as well as the reported late follow-up for all transient ischemic attacks after carotid endarterectomy in the literature (1.8% per year, 17 publications, 1980 operations). Thus amaurosis fugax appears to be a particularly favorable indication for carotid endarterectomy. Left untreated, this event carries a high risk of stroke; after carotid endarterectomy, which has a low operative risk, there is a very low postoperative stroke rate (two strokes in 448 patient-years of follow-up).