Carotid endarterectomy. One solution to the stroke problem.

Stroke is most often the result of extracranial cerebral artery disease; stroke carries a high initial mortality and morbidity and portends an increased risk of subsequent stroke or myocardial infarction. Stroke is also a preventable disease in more than one half of patients, either by approximate treatment of premonitory transient ischemic attacks or by appropriate evaluation of otherwise asymptomatic carotid bruits. Combined patient education and referring physician awareness should result in a declining incidence of stroke in this country. Two hundred carotid endarterectomies were performed over a 4-year period by senior residents under the direct supervision of the authors. Operative mortality was 1.5 per cent; perioperative stroke, 1.5 per cent; temporary neurologic deficit, 1 per cent; and temporary cranial nerve injury, 1 per cent. Analysis of these patients and of the literature supports an aggressive approach to carotid endarterectomy for patients with focal transient ischemic attacks and a more cautious approach for patients with prior stroke or asymptomatic stenoses.