Asymptomatic carotid lesions after endarterectomy of contralateral carotid artery. Five-year follow-up study and prognosis
T. Schroeder, U. J. Helgstrand, M. R. Egeblad and H. C. Engell
Of 185 patients who consecutively underwent carotid endarterectomy five
years ago, 135 had a patent asymptomatic contralateral internal carotid
artery (ICA). During follow-up (median, 59 months), 36 patients developed
new neurologic symptoms (18 strokes and 18 transient ischemic attacks).
Thirteen patients developed symptoms referable to the territory of the
previously asymptomatic ICA (five strokes and eight transient ischemic
attacks). Using life-table analysis, the annual stroke rate was estimated
to be 1% and 2.2% considering the previously asymptomatic and symptomatic
ICA, respectively. Separating patients according to the degree of stenosis
on the preoperative angiogram and according to the presence of ulceration
revealed a significantly higher incidence of neurologic events and strokes
in patients with stenoses exceeding 50% and/or patients with obvious
ulcerations. Although the risk of stroke without warning was increased in
these subgroups, we did not consider the risk high enough to warrant
prophylactic endarterectomy. An exception enough to warrant prophylactic
endarterectomy. An exception may be the patient with a more than 90%
stenosis.
