[Must acute carotid thrombosis be surgically treated? 1962-1973: long-term results]

A study of long-term results (mean follow-up: 10.6 years) in 22 patients operated on for acute carotid thrombosis between 1962 and 1973 is reported. In most instances, surgery was performed at the acute phase of a massive cerebrovascular occlusion, usually more than 8 hours after onset (10 cases). Five of these patients (22%) died in the postoperative period. Eight (35%) recovered without residual disease. In six, the condition improved, while it remained unchanged or worsened in three (14%). There were ten delayed deaths, including two from a recurrent cerebrovascular episode and four from cardiac disease. The actuarial survival curve does not differ from that of patients treated conservatively, with rates being 60% at five years, 36% at ten years and 28% at thirteen years. The quality of certain postoperative results suggests that surgical indications at the acute stage of carotid occlusion be reviewed. The study of thirty series from the literature (1 046 cases) shows a 17% mortality rate, while 50% of patients recover or improve. This mortality is significantly lower in recent statistics, under 10%: this improvement may be ascribable to more rigid surgical indications (delay under 6 hours, operation in variable neurologic deficiencies, early diagnosis by the Doppler procedure, better postoperative management). The authors conclude that surgical management of acute carotid thrombosis should no longer be systematically dismissed.