Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1986 Aug;204(2):154–162. doi: 10.1097/00000658-198608000-00009

Surgical versus nonoperative treatment of symptomatic carotid stenosis. 211 patients documented by intravenous angiography.

N R Hertzer, R A Flanagan Jr, E G Beven, P J O'Hara
PMCID: PMC1251256  PMID: 3527088

Abstract

From 1980 through 1982, intravenous extracranial digital subtraction angiography (DSA) was performed in 6684 patients at the Cleveland Clinic. Of these, 211 previously unoperated patients had prior transient ischemic attacks (TIA) or strokes in conjunction with greater than 50% carotid stenosis on unequivocal DSA studies. Nonoperative management was employed in 126 patients, including 120 (84%) who received antiplatelet therapy or formal anticoagulation. The remaining 85 patients underwent carotid endarterectomy. During a mean follow-up interval of 36 months, there was no overall difference in survival, late TIA, or stroke between the nonoperated and surgical cohorts. However, parity was maintained in these groups only because of the prevalence of intermediate (50-69%) stenotic lesions and stable internal carotid occlusions in the nonoperated group. Carotid endarterectomy provided superior stroke prevention for patients with greater than 70% unilateral stenosis (p = 0.04), for those with greater than 50% bilateral stenosis (p = 0.004), and for those with internal carotid occlusions associated with greater than 50% contralateral stenosis (p = 0.03). The special risk of such discrete subsets should be recognized in order to plan appropriate treatment at the present time, as well as to conduct safe clinical trials in the future.

Full text

PDF

Images in this article

156FIG. 1.
on p.156
156FIG. 1.
on p.156

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bardin J. A., Bernstein E. F., Humber P. B., Collins G. M., Dilley R. B., Devin J. B., Stuart S. H. Is carotid endarterectomy beneficial in prevention of recurrent stroke? Arch Surg. 1982 Nov;117(11):1401–1407. doi: 10.1001/archsurg.1982.01380350009002. [DOI] [PubMed] [Google Scholar]
  2. Barnett H. J., Plum F., Walton J. N. Carotid endarterectomy--an expression of concern. Stroke. 1984 Nov-Dec;15(6):941–943. doi: 10.1161/01.str.15.6.941. [DOI] [PubMed] [Google Scholar]
  3. Bernstein E. F., Humber P. B., Collins G. M., Dilley R. B., Devin J. B., Stuart S. H. Life expectancy and late stroke following carotid endarterectomy. Ann Surg. 1983 Jul;198(1):80–86. doi: 10.1097/00000658-198307000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. CUTLER S. J., EDERER F. Maximum utilization of the life table method in analyzing survival. J Chronic Dis. 1958 Dec;8(6):699–712. doi: 10.1016/0021-9681(58)90126-7. [DOI] [PubMed] [Google Scholar]
  5. Carson S. N., Demling R. H., Esquivel C. O. Aspirin failure in symptomatic atherosclerotic carotid artery disease. Surgery. 1981 Dec;90(6):1084–1092. [PubMed] [Google Scholar]
  6. Connolly J. E., Brownell D. A., Levine E. F., McCart P. M. Accuracy and indications of diagnostic studies for extracranial carotid disease. Arch Surg. 1985 Nov;120(11):1229–1232. doi: 10.1001/archsurg.1985.01390350015004. [DOI] [PubMed] [Google Scholar]
  7. Dyken M. L., Pokras R. The performance of endarterectomy for disease of the extracranial arteries of the head. Stroke. 1984 Nov-Dec;15(6):948–950. doi: 10.1161/01.str.15.6.948. [DOI] [PubMed] [Google Scholar]
  8. Gee W., McDonald K. M., Kaupp H. A., Celani V. J., Bast R. G. Carotid stenosis plus occlusion: endarterectomy or bypass? Arch Surg. 1980 Feb;115(2):183–187. doi: 10.1001/archsurg.1980.01380020049012. [DOI] [PubMed] [Google Scholar]
  9. Hertzer N. R., Arison R. Cumulative stroke and survival ten years after carotid endarterectomy. J Vasc Surg. 1985 Sep;2(5):661–668. [PubMed] [Google Scholar]
  10. Imparato A. M., Riles T. S., Mintzer R., Baumann F. G. The importance of hemorrhage in the relationship between gross morphologic characteristics and cerebral symptoms in 376 carotid artery plaques. Ann Surg. 1983 Feb;197(2):195–203. doi: 10.1097/00000658-198302000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lee E. T., Desu M. M. A computer program for comparing K samples with right-censored data. Comput Programs Biomed. 1972 Nov;2(4):315–321. doi: 10.1016/0010-468x(72)90019-0. [DOI] [PubMed] [Google Scholar]
  12. Lusby R. J., Ferrell L. D., Ehrenfeld W. K., Stoney R. J., Wylie E. J. Carotid plaque hemorrhage. Its role in production of cerebral ischemia. Arch Surg. 1982 Nov;117(11):1479–1488. doi: 10.1001/archsurg.1982.01380350069010. [DOI] [PubMed] [Google Scholar]
  13. McCullough J. L., Mentzer R. M., Jr, Harman P. K., Kaiser D. L., Kron I. L., Crosby I. K. Carotid endarterectomy after a completed stroke: reduction in long-term neurologic deterioration. J Vasc Surg. 1985 Jan;2(1):7–14. [PubMed] [Google Scholar]
  14. O'Donnell T. F., Jr, Erdoes L., Mackey W. C., McCullough J., Shepard A., Heggerick P., Isner J., Callow A. D. Correlation of B-mode ultrasound imaging and arteriography with pathologic findings at carotid endarterectomy. Arch Surg. 1985 Apr;120(4):443–449. doi: 10.1001/archsurg.1985.01390280037009. [DOI] [PubMed] [Google Scholar]
  15. Riles T. S., Imparato A. M., Kopelman I. Carotid artery stenosis with contralateral internal carotid occlusion: long-term results in fifty-four patients. Surgery. 1980 Apr;87(4):363–368. [PubMed] [Google Scholar]
  16. Rutkow I. M., Ernst C. B. Vascular surgical manpower. Too much? Enough? Too little? Unknown? Arch Surg. 1982 Dec;117(12):1537–1542. doi: 10.1001/archsurg.1982.01380360013004. [DOI] [PubMed] [Google Scholar]
  17. Sachs S. M., Fulenwider J. T., Smith R. B., 3rd, Darden W. A., Salam A. A., Perdue G. D. Does contralateral carotid occlusion influence neurologic fate of carotid endarterectomy? Surgery. 1984 Nov;96(5):839–844. [PubMed] [Google Scholar]
  18. Toole J. F., Yuson C. P., Janeway R., Johnston F., Davis C., Cordell A. R., Howard G. Transient ischemic attacks: a prospective study of 225 patients. Neurology. 1978 Aug;28(8):746–753. doi: 10.1212/wnl.28.8.746. [DOI] [PubMed] [Google Scholar]
  19. Warlow C. Carotid endarterectomy: does it work? Stroke. 1984 Nov-Dec;15(6):1068–1076. doi: 10.1161/01.str.15.6.1068. [DOI] [PubMed] [Google Scholar]
  20. Whisnant J. P., Cartlidge N. E., Elveback L. R. Carotid and vertebral-basilar transient ischemic attacks: effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence--a population study. Ann Neurol. 1978 Feb;3(2):107–115. doi: 10.1002/ana.410030204. [DOI] [PubMed] [Google Scholar]
  21. Whisnant J. P., Sandok B. A., Sundt T. M., Jr Carotid endarterectomy for unilateral carotid system transient cerebral ischemia. Mayo Clin Proc. 1983 Mar;58(3):171–175. [PubMed] [Google Scholar]
  22. Ziegler D. K., Hassanein R. S. Prognosis in patients with transient ischemic attacks. Stroke. 1973 Jul-Aug;4(4):666–673. doi: 10.1161/01.str.4.4.666. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES