[Internal medicine aspects in patients with operable carotid lesions]

Cerebral insufficiency with or without neurological deficits (n.d.) may be treated effectively surgically by carotid artery reconstruction or by extra-intracranial anastomoses. The low mortality of these operations and the favourable results including prevention of new n.d. and amelioration of long standing n.d. suggest consideration of operation in geriatric patients. Noninvasive screening methods for cranial artery pathology such as neck auscultation, direct and indirect Doppler ultrasonic investigations and dynamic and static cerebral scan therefore should be performed not only in all patients with overt cerebrovascular insufficiency whatever degree but also in patients with hypertension, diabetes mellitus, ischemic heart disease and occlusive disease of the extremities on account of the high incidence of multivascular disease in these patients. We compared 60 consecutive patients before and beyond the age of 70 respectively, treated surgically for cerebrovascular insufficiency. The only significant differences apart from age were a higher rate of pathologic findings of the heart on x-ray and on the ecg in the aged. Despite this mortality, major complications and favourable results were not different for both age groups. These results favour an active approach to diagnosis and indication to surgical treatment not only in young patients but also in the symptomatic geriatric patient.