The long-term results of carotid endarterectomy for transient ischemic attacks

One hundred patients who underwent carotid endarterectomy for transient ischemic attacks (TIAs) have been followed up for 3 to 10 years (mean, 5.5 years). Seven patients have been lost to follow-up but none is recorded as dead (National Registry of Deaths) at least 5 years after operation. Fifteen patients (16.5%) have died, four from cerebral and eight from cardiac causes. Three patients had cerebral infarction with permanent deficits, one occurring immediately after operation, one at 3 months, and one at 9 years. Four patients had minor strokes but a full clinical recovery, three patients postoperatively and one patient at 4 years. Fourteen patients had ipsilateral TIAs, four occurred postoperatively and 10 occurred from 1 to 8 years later. Ten patients had contralateral TIAs and five patients then had a contralateral carotid endarterectomy. Another nine patients also had bilateral operations, three for bilateral TIAs, five as prophylactic procedures on the basis of arteriographic findings, and one for a contralateral cerebral event that occurred after arteriography. Thus, at the mean follow-up time (5.5 years) and including the operative complications, four deaths (4%) of cerebral origin and seven serious cerebral problems (7%) have occurred--an annual morbidity and mortality rate of less than 2%. This compares favorably with the commonly predicted rate of stroke occurring after TIAs of 5% per year. These figures support the argument that carotid endarterectomy reduces the incidence of stroke occurring after TIA and stops TIAs caused by emboli from the carotid bifurcation.