[Hemodynamic effect of carotid stenoses and longtime course following carotid surgery]

Between 1962 and 1980, a total of 706 patients with chronic arteriosclerotic vascular changes or kinking or coiling of the carotid artery, were subjected to surgery at the Surgical Department of the University Hospital at Erlangen. In 1981, a total of 703 patients were analysed to obtain information about the postoperative course. In addition to a computation of the survival rates, together with the stroke rates, broken down by the clinical stage, the preoperative haemodynamic effect of the carotid stenosis was taken into account. Patients with transient ischaemic attacks or mild cerebral infarction affecting the carotid artery territory, revealed a favourable long-term survival rate, and a low rate of strokes, irrespective of whether haemodynamically effective carotid stenoses presented or not. Patients with asymptomatic carotid artery stenosis, with chronic cerebral ischaemia, with non-hemispheric attacks, and with completed cerebral infarction, revealed, all in all, no favourable survival rates. For patients with preoperative haemodynamically effective carotid stenoses, the incidence of strokes was markedly lower than in patients without haemodynamically effective stenoses. This means that an indication for carotid artery surgery in these patients, can only be justified if the carotid stenosis is haemodynamically effective, but not if the stenosis is lowgrade.