[Current status of the surgery of carotid stenoses]

In a series of 472 operations performed in 420 patients between 1981 and 1982, the mortality rate was 1.1% in asymptomatic patients (stage 0) and 2.1% in patients with transient ischaemic attacks (stage I) or with minor neurological sequelae (stage III). The morbidity rate of serious sequelae was 1.05%. The long term mortality is 30% at 5 years and 50% at 10 years, in most of the major statistical studies. The major cause of death (more than 50%) is myocardial infarction. The study of the local evolution of the operated artery reveals that about 10% of the patients who survived between 5 to 10 years had a recurrent carotid artery stenosis. Comparative studies of the course of the atherosclerotic disease operated patients and in patients treated medically are difficult to evaluate. However, most authors agree with Fields that an operation is justified in asymptomatic patients and in those presenting transient ischaemic attacks, provided the mortality and morbidity rate is less than 3%. Finally, recent studies stress the value of non-invasive investigations for determining the prognosis of tight stenoses: in asymptomatic patients with tight stenoses, the risk of a cerebrovascular accident is 5 times greater than in patients with a minor stenosis.