Emergency carotid artery surgery in neurologically unstable patients
J. Goldstone and W. S. Moore
Although angiography and carotid artery surgery are illadvised in patients
with acute, profound stroke, there is no consensus on the management of
patients with stroke in evolution, waxing and waning neurologic deficits,
or crescendo transient ischemic attacks. This type of clinical picture was
associated with a critical, unstable lesion of the internal carotid artery
in each of 12 patients. Emergency angiography permitted identification of
the lesions responsible for the varying neurologic manifestations, and
emergency carotid thromboendarterectomy produced prompt, complete recovery
in all but one patient, who had a total carotid occlusion, received no
operation, and died of a cerebral infarction. Based on our experience with
these 12 patients, an aggressive diagnostic and therapeutic approach is
recommended for patients with acute unstable cerebrovascular disease.
