Carotid endarterectomy: how does it work? A clinical and angiographic evaluation

In a retrospective study, the clinical and angiographic results were evaluated of 100 consecutive carotid endarterectomies, carried out in 90 patients over the period 1977 to 1983. There was no operation-associated mortality; the perioperative morbidity was 5%. Angiography, carried out, on average, 4.2 months postoperatively, revealed complete occlusion of the operated carotid artery in 16 cases (18.5%); in at least 13 cases this was completely asymptomatic. Perioperative findings suggest that microembolism is, but haemodynamic insufficiency is not, an important cause of focal cerebral ischemia. Therefore, treatment for extracranial atherosclerotic cerebrovascular disease should be focused on the elimination of the source of embolism rather than on an improvement of cerebral blood flow.