Reflections from a decade of carotid reconstructive surgery.

Carotid artery reconstructive surgery for atherosclerotic lesions of the extracranial cerebral circulation has become the most common operation in peripheral vascular surgery. A better understanding of the indications for operative intervention, enhanced monitoring during surgery, and more precise management of intraoperative anesthesia have all helped decrease the risks associated with internal carotid endarterectomy. To evaluate the safety and efficacy of extracranial carotid reconstructive surgery, we reviewed 2,857 operations done on 2,087 patients from 1976 to 1985. Operation was recommended because of hemispheric symptoms in 58%, and because of asymptomatic, significant stenosis in 14%. Postoperative hemiparesis occurred in 24 patients and was associated with thrombosis at the operative site in 18 patients. Antiplatelet drugs used during the last three years were found to be effective in preventing thrombosis at the operative site. Operative mortality during the study period was 1.5%. Follow-up has ranged from one month to 104 months, with 84% of the patients alive and 79% symptom free.