Carotid endarterectomy: early and late results in 161 patients

Over a 15-year period, 161 patients underwent 186 carotid endarterectomies. Of these patients, 97% had symptoms preoperatively. The incidence of new neurologic deficits appearing immediately postoperatively was 7% (13 of 186), and 1.6% (3 of 186) were major permanent strokes. Nineteen patients were lost to follow-up. The cumulative patient survival was 83% at 5 years and 59% at 10 years. The cause of death in the late postoperative period was ascertained in 22 of 24 patients; it was related to ischemic cardiac disease in 16. There were no late deaths from neurologic complications. New or recurrent neurologic symptoms developed in the late postoperative period in 22 patients. There were no disabling strokes in this group. The cumulative rate of freedom from new neurologic symptoms was 82% at 5 years and 71% at 10 years. Repeat angiography was carried out in 12 patients who had new or recurrent neurologic symptoms in the late postoperative period. The repaired artery was found to be widely patent in nine, stenosed in one and occluded in two. Reoperation of the same carotid was not performed in this series. Routine intraoperative angiography aided the detection and correction of potential technical problems.