Recurrent transient ischemic attacks after carotid endarterectomy.

The postoperative courses of 113 patients undergoing 121 carotid endarterectomies between 1974 and 1979 were analyzed for recurrent transient ischemic attacks (TIAs). The TIAs were the indication for the original operation in all patients; 31 patients had a stable neurologic deficit prior to operation. Two patients sustained major strokes and three had nondisabling minor strokes. Three patients had late strokes. Recurrent TIAs occurred during follow-up in 28 patients, and these were classified into four distinct categories: (1) Ten patients had single TIAs in the distribution of the carotid artery operated on in the early postoperative days. (2) Four patients had late, repetitive TIAs related to the operated side. (3) Five patients had late TIAs in the distribution of the contralateral artery. (4) Nine patients had single or multiple TIAs owing to recurrent vertebrobasilar insufficiency. Close, long-term follow-up of postendarterectomy patients is recommended to locate those who will have surgically correctable lesions.