Operative versus nonoperative management of asymptomatic high-grade internal carotid artery stenosis: Improved results with endarterectomy

Gregory L. Moneta, David C. Taylor, Stephen C. Nicholls, Robert O. Bergelin, R. Eugene Zierler, Andris Kazmers, Alexander W. Clowes, D. Eugene Strandness

    Research output: Contribution to journalArticlepeer-review

    109 Scopus citations

    Abstract

    In a 4-year period, 129 asymptomatic high-grade (80-99%) internal carotid artery stenoses were identified in 115 patients. Because we previously demonstrated a strong relation between degree of carotid stenosis and subsequent development of ipsilateral related events (stroke, transient ischemic attack, and carotid occlusion), we changed our previous policy and began to offer carotid endarterectomy to good surgical risk patients referred to us with asymptomatic high-grade carotid stenosis. A total of 56 carotid endarte rectomies were performed while 73 lesions were followed nonopera tively. Operated and nonope rated groups were similar with regard to age, prevalence of hypertension, cardiac disease, diabetes, and aspirin use. Life table analysis to 24 months revealed a higher rate of stroke (19 vs. 4%, p = 0.08), transient focal neurologic deficits (28 vs. 5%, p = 0.008), and carotid occlusion (29 vs. 0%, p = 0.003) in the nonoperated group. Eight of the 9 strokes in the nonoperated group occurred within 9 months of diagnosis of the high-grade lesion; none were preceded by a transient ischemic attack. There was 1 perioperative stroke (1.8%) but no in-hospital operative deaths and no difference in the late death rates of the two groups. This suggests that the preservation of neurologic status in patients with asymptomatic high-grade internal carotid artery stenosis can be improved by carotid endarterectomy.

    Original languageEnglish (US)
    Pages (from-to)1005-1010
    Number of pages6
    JournalStroke
    Volume18
    Issue number6
    DOIs
    StatePublished - 1987

    ASJC Scopus subject areas

    • Clinical Neurology
    • Cardiology and Cardiovascular Medicine
    • Advanced and Specialized Nursing

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