Carotid endarterectomy in patients with actively changing neurological deficits--correlations with CT brain scans

The place of carotid endarterectomy in patients with actively changing neurological deficits (ACND) is yet to be defined. This is a study of 15 patients with ACND who underwent carotid endarterectomy. All patients had demonstrable neurological deficits at the time of surgery. However no patient had severe devastating symptomatology or decreased levels of consciousness. Eight patients (Group I) were classified as stroke-in-evolution (SIE) according to Millikan. Seven other patients (Group II) were also unstable with deficits of recent onset but did not demonstrate a classical progressive or stepwise deterioration. Average internal carotid stenosis was 80% (range 50-90%). In each of the Group I patients CT scans of the brain demonstrated cerebral infarction in the area appropriate to the deficit. CT scans were performed in four of the Group II patients, two of whom showed cerebral infarction while two were normal. Seven of the eight Group I patients improved after surgery while one progressed to a completed stroke. Six of the seven Group II patients improved following surgery while one died on the third postoperative day. These results suggest an improved outlook with surgery when compared either with the natural history of SIE or with the results when anticoagulants alone are used.