Natural history of nonstenotic, asymptomatic ulcerative lesions of the carotid artery. A further analysis.

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.