[Cervical carotid endarterectomy. Evaluation of a 12 years' experience (260 operations)]

Abstract

From 1978 to 1989, 235 patients were operated upon with 260 procedures for cervical carotid endarterectomy. The patients were classified according to the presence or absence of ischemic symptomatology, and for symptomatic patients, according to the reversibility or persistence of ischemic symptoms. So the selection of patients was: reversible ischemia 46%, stroke 29%, asymptomatic patients 25%. In the stroke group, no patient was operated on in emergency, the endarterectomy was performed after stabilization of the patients. Three subgroups were included in patients operated on for asymptomatic carotid stenosis: casual discovery 40%, treatment of the second carotid artery (previous endarterectomy for symptomatic controlateral carotid artery) 34%, and treatment of the second carotid artery (previous ECIC Bypass for controlateral occluded artery) 26%. All patients were operated upon after angiographic exploration (femoral catheterism in most cases), and after cerebral CT Scan. The surgical technique included general anesthesia, systematic shunting, endarterectomy after longitudinal arteriotomy, closure without patch. The operative microscope has been used since 1985. The operatives results were studied in terms of uneventful post-operative course (87.3%), reversible complications (8.1%) and long lasting complications (4.6%). The long lasting complications were of local origin (1.1%), of neurological origin (2.3%), of general origin (1.2%). Overall the operative results at 6 months were: return to previous clinical state 95.4%, neurological sequellae 1.5%, deaths 3.1%. In patients operated on for asymptomatic carotid stenosis the overall results were: previous clinical state 97%, death 3%. The legitimy of carotid endarterectomy procedure is discussed in view of some recent pertinent literature.