Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1989 Sep;210(3):308–316. doi: 10.1097/00000658-198909000-00006

Long-term follow-up of surgically managed carotid bifurcation atherosclerosis. Justification for an aggressive approach.

A D Callow 1, W C Mackey 1
PMCID: PMC1357992  PMID: 2774707

Abstract

To document the efficacy of our aggressive surgical approach to stroke prevention, we compiled follow-up data on 619 patients undergoing 993 carotid endarterectomies at our institution since 1970. Following carotid endarterectomy, crude annual stroke incidence, including perioperative strokes (2.2%), was 1.9%. In our symptomatic patients crude annual stroke incidence, including perioperative strokes (2.7%), was 2.1%. This is superior to the annual stroke incidence seen in patients on "optimal" medical therapy as defined by the Canadian Cooperative Study (4.6% in men), the AICLA Study (2.9%), the American Multicenter Trial (8%), and the Canadian- American Cooperative Trial (approximately 5%). In our asymptomatic patients, crude annual stroke incidence, including perioperative strokes (1.1%), was 1.4%. This is superior to nonsurgical therapy for asymptomatic patients with hemodynamically significant or more than 75% stenoses as reported by the Mayo Clinic (3.4%) or Chambers and Norris (2.7%). An aggressive surgical approach to carotid bifurcation atherosclerosis is superior to nonsurgical therapy in symptomatic and selected asymptomatic patients if low perioperative mortality/stroke morbidity rates are achieved.

Full text

PDF
308

Selected References

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

  1. Bauer R. B., Meyer J. S., Fields W. S., Remington R., Macdonald M. C., Callen P. Joint study of extracranila arterial occlusion. 3. Progress report of controlled study of long-term survival in patients with and without operation. JAMA. 1969 Apr 21;208(3):509–518. doi: 10.1001/jama.208.3.509. [DOI] [PubMed] [Google Scholar]
  2. 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]
  3. Blaisdell W. F., Clauss R. H., Galbraith J. G., Imparato A. M., Wylie E. J. Joint study of extracranial arterial occlusion. IV. A review of surgical considerations. JAMA. 1969 Sep 22;209(12):1889–1895. [PubMed] [Google Scholar]
  4. Bousser M. G., Eschwege E., Haguenau M., Lefaucconnier J. M., Thibult N., Touboul D., Touboul P. J. "AICLA" controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia. Stroke. 1983 Jan-Feb;14(1):5–14. doi: 10.1161/01.str.14.1.5. [DOI] [PubMed] [Google Scholar]
  5. Brott T., Thalinger K. The practice of carotid endarterectomy in a large metropolitan area. Stroke. 1984 Nov-Dec;15(6):950–955. doi: 10.1161/01.str.15.6.950. [DOI] [PubMed] [Google Scholar]
  6. Callow A. D. David M. Hume Memorial Lecture. An overview of the stroke problem in the carotid territory. Am J Surg. 1980 Aug;140(2):181–191. doi: 10.1016/0002-9610(80)90002-1. [DOI] [PubMed] [Google Scholar]
  7. Callow A. D. Recurrent stenosis after carotid endarterectomy. Arch Surg. 1982 Aug;117(8):1082–1085. doi: 10.1001/archsurg.1982.01380320066017. [DOI] [PubMed] [Google Scholar]
  8. Chambers B. R., Norris J. W. Outcome in patients with asymptomatic neck bruits. N Engl J Med. 1986 Oct 2;315(14):860–865. doi: 10.1056/NEJM198610023151404. [DOI] [PubMed] [Google Scholar]
  9. Chambers B. R., Norris J. W. The case against surgery for asymptomatic carotid stenosis. Stroke. 1984 Nov-Dec;15(6):964–967. doi: 10.1161/01.str.15.6.964. [DOI] [PubMed] [Google Scholar]
  10. Cossman D. V., Treiman R. L., Foran R. F., Levin P. M., Cohen J. L. Surgical approach to recurrent carotid stenosis. Am J Surg. 1980 Aug;140(2):209–211. doi: 10.1016/0002-9610(80)90007-0. [DOI] [PubMed] [Google Scholar]
  11. DeWeese J. A., Rob C. G., Satran R., Marsh D. O., Joynt R. J., Summers D., Nichols C. Results of carotid endarterectomies for transient ischemic attacks-five years later. Ann Surg. 1973 Sep;178(3):258–264. doi: 10.1097/00000658-197309000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Dyken M. L. Carotid endarterectomy studies: a glimmering of science. Stroke. 1986 May-Jun;17(3):355–358. doi: 10.1161/01.str.17.3.355. [DOI] [PubMed] [Google Scholar]
  13. 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]
  14. Easton J. D., Sherman D. G. Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations. Stroke. 1977 Sep-Oct;8(5):565–568. doi: 10.1161/01.str.8.5.565. [DOI] [PubMed] [Google Scholar]
  15. Fields W. S. Aspirin for prevention of stroke: a review. Am J Med. 1983 Jun 14;74(6A):61–65. doi: 10.1016/0002-9343(83)90530-2. [DOI] [PubMed] [Google Scholar]
  16. Fields W. S., Lemak N. A., Frankowski R. F., Hardy R. J. Controlled trial of aspirin in cerebral ischemia. Stroke. 1977 May-Jun;8(3):301–314. doi: 10.1161/01.str.8.3.301. [DOI] [PubMed] [Google Scholar]
  17. Fields W. S., Maslenikov V., Meyer J. S., Hass W. K., Remington R. D., Macdonald M. Joint study of extracranial arterial occlusion. V. Progress report of prognosis following surgery or nonsurgical treatment for transient cerebral ischemic attacks and cervical carotid artery lesions. JAMA. 1970 Mar 23;211(12):1993–2003. doi: 10.1001/jama.211.12.1993. [DOI] [PubMed] [Google Scholar]
  18. Fields W. S., North R. R., Hass W. K., Galbraith J. G., Wylie E. J., Ratinov G., Burns M. H., Macdonald M. C., Meyer J. S. Joint study of extracranial arterial occlusion as a cause of stroke. I. Organization of study and survey of patient population. JAMA. 1968 Mar 11;203(11):955–960. [PubMed] [Google Scholar]
  19. Hass W. K., Fields W. S., North R. R., Kircheff I. I., Chase N. E., Bauer R. B. Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites, and complications. JAMA. 1968 Mar 11;203(11):961–968. [PubMed] [Google Scholar]
  20. 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]
  21. Heyman A., Wilkinson W. E., Heyden S., Helms M. J., Bartel A. G., Karp H. R., Tyroler H. A., Hames C. G. Risk of stroke in asymptomatic persons with cervical arterial bruits: a population study in Evans County, Georgia. N Engl J Med. 1980 Apr 10;302(15):838–841. doi: 10.1056/NEJM198004103021504. [DOI] [PubMed] [Google Scholar]
  22. Matsumoto G. H., Cossman D., Callow A. D. Hazards and safeguards during carotid endarterectomy. Technical considerations. Am J Surg. 1977 Apr;133(4):458–462. doi: 10.1016/0002-9610(77)90131-3. [DOI] [PubMed] [Google Scholar]
  23. Meissner I., Wiebers D. O., Whisnant J. P., O'Fallon W. M. The natural history of asymptomatic carotid artery occlusive lesions. JAMA. 1987 Nov 20;258(19):2704–2707. [PubMed] [Google Scholar]
  24. Rosenthal D., Rudderman R., Borrero E., Hafner D. H., Perdue G. D., Lamis P. A., Clark M. D., Daniel W. W. Carotid endarterectomy to correct asymptomatic carotid stenosis: ten years later. J Vasc Surg. 1987 Sep;6(3):226–230. doi: 10.1067/mva.1987.avs0060226. [DOI] [PubMed] [Google Scholar]
  25. Stewart G., Ross-Russell R. W., Browse N. L. The long-term results of carotid endarterectomy for transient ischemic attacks. J Vasc Surg. 1986 Dec;4(6):600–605. doi: 10.1067/mva.1986.avs0040600. [DOI] [PubMed] [Google Scholar]
  26. Suggested standards for reports dealing with lower extremity ischemia. Prepared by the Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg. 1986 Jul;4(1):80–94. [PubMed] [Google Scholar]
  27. Thompson J. E., Patman R. D., Talkington C. M. Asymptomatic carotid bruit: long term outcome of patients having endarterectomy compared with unoperated controls. Ann Surg. 1978 Sep;188(3):308–316. doi: 10.1097/00000658-197809000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Thompson J. E., Talkington C. M. Carotid endarterectomy. Ann Surg. 1976 Jul;184(1):1–15. doi: 10.1097/00000658-197607000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. 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]
  30. Winslow C. M., Solomon D. H., Chassin M. R., Kosecoff J., Merrick N. J., Brook R. H. The appropriateness of carotid endarterectomy. N Engl J Med. 1988 Mar 24;318(12):721–727. doi: 10.1056/NEJM198803243181201. [DOI] [PubMed] [Google Scholar]
  31. Wolf P. A., Kannel W. B., Sorlie P., McNamara P. Asymptomatic carotid bruit and risk of stroke. The Framingham study. JAMA. 1981 Apr 10;245(14):1442–1445. [PubMed] [Google Scholar]

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

RESOURCES