Prevention of stroke by carotid endarterectomy.

Cerebral stroke can occur in patients having visual symptoms only. Fundoscopy is valuable in identifying those patients with visual symptoms who are likely to have carotid disease; and carotid endarterectomy can prevent a stroke in a significant percentage of patients at risk. Meticulous operative technique is essential. In a series of 187 carotid endarterectomies performed on 154 patients over a 7-year period, the operative mortality rate was zero. Operative morbidity was 1.3% in 139 patients who had no prior permanent neurological deficits, and 13% in 15 patients who had suffered previous strokes. Data compiled on follow-up for an average of 20 months indicated that six patients (4.7%) suffered postoperative strokes, nine patients (7%) experienced persistence of symptoms, and 113 patients (88.3%) remained neurologically well.