Carotid endarterectomy for nonhemispheric cerebral symptoms: patient selection with ocular pneumoplethysmography.

Carotid endarterectomy fails to ameliorate nonhemispheric cerebral symptoms in an unacceptably high proportion of patients, specifically those patients with minor, hemodynamically insignificant carotid lesions. Ocular pneumoplethysmography (OPG) has been shown to accurately predict the hemodynamic significance of carotid lesions, but its use has not been applied to the subset of patients with nonhemispheric symptoms. Preoperative OPG studies were obtained in 43 patients with nonhemispheric symptoms. Postoperatively, 72% of patients with OPG suggestive of hemodynamically significant carotid lesions were relieved of symptoms. By contrast, only 32% of patients with normal OPG were asymptomatic after carotid surgery (p less than 0.05, life-table methods, 24-month follow-up). These data suggest that OPG is a useful test to determine which patients with nonhemispheric cerebral symptoms will benefit from carotid revascularization.