Cumulative stroke and survival ten years after carotid endarterectomy.

With the life-table method, late stroke and survival data were calculated for 329 patients (mean age 59 years) followed a minimum of 10 years after carotid endarterectomy. The cumulative incidence of stroke was 24% at 10 years after operation, but only 10% of patients sustained strokes that clearly involved the ipsilateral cerebral hemisphere. Late strokes were most common (p less than or equal to 0.05) among hypertensive patients (31%), those with preoperative strokes (31%), and patients with recognized contralateral carotid stenosis (42%). Contralateral hemispheric strokes occurred in 36% of patients with uncorrected contralateral stenosis compared with 8% of those who had elective bilateral reconstruction (p = 0.09). Myocardial infarctions caused more late deaths (37%) than did strokes (15%), and 10-year survival after incidental myocardial revascularization (55%) was superior (p = 0.0001) to survival for patients with suspected but undocumented coronary disease (32%).