Carotid endarterectomy for cerebrovascular insufficiency. Long term follow-up of 141 patients followed up to sixteen years.

Between 1962 and 1978 one hundred and fifty-nine endarterectomies were performed on 141 patients. The operation was done under general anesthesia with the use of a shunt and hypertension as cerebral protection. The arteriotomy was closed using a dacron patch. The postoperative evolution of every neurological symptom was analysed after a follow-up of up to sixteen years. The patients were divided in three groups following their neurological and anatomical situation. On 43 totally asymptomatic patients (group I), there was one perioperative death, 41 remained totally asymptomatic and one developed a transient ischemic attack on the non operative side. On 25 patients (group II) operated after symptomatic contralateral total occlusion, fifteen became asymptomatic, six improved seriously, one remained unchanged, and one suffered from a stroke with complete recuperation. Two perioperative deaths were encountered in this group. On the 73 patients from group III, there were three perioperative deaths. Fifty-two patients became totally asymptomatic, nine patients had a serious amelioration of their residu. Three remained unchanged. Five patients suffered from a long term deterioration of their neurological condition and one patient developed an anastomotic aneurysm.