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Jerry Goldstone, MD; Wesley S. Moore, MD

Arch Surg. 1976;111(11):1284-1291.

Abstract
• Although angiography and carotid artery surgery are ill-advised 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.

(Arch Surg 111:1284-1291, 1976)

Author Affiliations
From the Department of Surgery, University of California, Fort Miley Veterans Administration Hospital, San Francisco.

Footnotes
Accepted for publication July 9, 1976.

Read before the 24th scientific meeting of the International Cardiovascular Society, Albuquerque, NM, June 19, 1976.

Reprint requests to Department of Surgery, University of California, 4150 Clement St, San Francisco, CA 94121 (Dr Goldstone).

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