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A Further Analysis

Sherwood Dixon, MD; S. Osher Pais, MD; Carol Raviola, MD; Antoinette Gomes, MD; Herbert I. Machleder, MD; J. Dennis Baker, MD; Ronald W. Busuttil, MD, PhD; Wiley F. Barker, MD; Wesley S. Moore, MD

Arch Surg. 1982;117(11):1493-1498.

Abstract
• The natural history of 153 asymptomatic, nonstenotic ulcerative lesions of the carotid bifurcation in 141 patients was reviewed. A technique for quantitatively defining small (A), large (B), and compound (C) ulcers was developed. During the course of study, extending up to ten years, 3% of patients with A ulcers, 21% with B ulcers, and 19% with C ulcers had hemispheric strokes without antecedent transient ischemic attacks (TIAs), on the side appropriate to the lesion. The interval annual stroke rate was 4.5% for B ulcers and 7.5% for C ulcers. Because these interval stroke rates are comparable to the 6% annual stroke rate occurring in patients with TIAs, a well-accepted indication for operation, we recommend prophylactic operation for these lesions in good surgical candidates, to be performed by surgeons who have demonstrably low operative stroke rates.

(Arch Surg 1982;117:1493-1498)

Author Affiliations
From the Departments of Surgery (Drs Dixon, Raviola, Machleder, Baker, Busuttil, Barker, and Moore) and Radiology (Drs Pais and Gomes), UCLA School of Medicine.

Footnotes
Accepted for publication July 19, 1982.

Read before the 30th scientific meeting of the International Cardiovascular Society, Boston, June 19, 1982.

Reprint requests to Section of Vascular Surgery, UCLA School of Medicine, Los Angeles, CA 90024 (Dr Moore).

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