Significance of ulcerated plaque in transient cerebral ischemia

The results of 210 endarterectomies in 174 patients are reviewed. The average age was 60.3 years for women and 62.1 years for men, with women comprising 53 percent of the population. Pathologic evaluation of tissue removed at time of surgery revealed macroscopic ulcerations in 50 percent of specimens and microscopic ulcerations in 33 percent, with 15 percent of specimens having both macroscopic and microscopic ulcerations. We were unable to identify a set of factors on the basis of symptoms or preoperative studies that would unequivocally indicate ulceration, but we believe that this study reinforces the concept that atheromatous embolization is probably a more frequent remedial cause of transient ischemic attacks than ischemia secondary to large vessel disease.