The value of carotid endarterectomy in reducing the morbidity and mortality of recurrent stroke.

Survivors of ischemic stroke are at high risk of sustaining recurrent strokes, which tend to be more severe and are often fatal. Controversy exists regarding whether or not carotid endarterectomy (CEA) achieves its objectives of preventing recurrent stroke and reducing subsequent death in such patients. Therefore, we analyzed the records of 275 consecutive patients who underwent 350 CEAs between 1977 and 1983 and identified 95 patients (34.5%) who had suffered a preoperative stroke, which was the primary indication for operation. All had either full recovery (13.7%) or only mild (63.2%) or moderate (23.1%) neurologic deficits at the time of operation. Patients with severe deficits did not undergo operation. The operations were performed whenever the neurologic recovery had reached a plateau, without a specific interim waiting period between the stroke and the operation. The combined operative morbidity/mortality rate was 2.7% (three patients), both deaths caused by stroke in patients with mild preoperative neurologic deficits and one (0.9%) nonfatal postoperative stroke involving the retina in a patient who also had a mild preoperative deficit. Long-term follow-up averaged 32 months (range, 6 to 72 months). No ipsilateral recurrent strokes occurred during this period after CEA. Life-table analysis revealed a recurrent stroke rate of 3.2% (0.64% per year) and a 5-year survival rate of 81.3%. Patients who were neurologically normal at the time of operation had a cumulative 5-year survival rate of 90.9%. None of the late deaths was due to recurrent stroke.(ABSTRACT TRUNCATED AT 250 WORDS)