The role of carotid endarterectomy in the treatment of acute neurologic deficits

Abstract

I N THE more than 25 yr since the first report of successful carotid artery reconstruction for symptoms of cerebral vascular insufficiency,’ the role of extracranial arterial surgery in the management of these disorders has become established. Carotid artery bifurcation endarterectomj is now an accepted form of therapy for selected patients with monocular or cerebral hemispheric transient ischemic attacks.*” Conversely, it is generally agreed that arteriography and carotid artery surgery should be avoided in patients with progressing and acute severe stroke, because of the risk of exacerbating the neurologic deficit.6.m9 However, a small percentage of patients have thromboembolic cerebral ischemia manifested by unstable neurologic deficits of only mild to moderate degree. There is no consensus on the indications for and timing of surgery in these patients, but most neurologists and vascular surgeons have treated them as acute strokes and withheld angiography and surgery. Because several such patients in whom this approach was followed progressed to a severe, fixed neurologic deficit, we adopted a more aggressive plan of management. This approach and the results of its use are described in this report.