Abstract

Abstract:Thirty-four neurologically asymptomatic patients had 42 prophylactic carotid artery reconstructive procedures before another major operation. Thirty-one of the 34 planned second operations in these patients were for management of concomitant atherosclerotic arterial disease which had produced symptoms. One death and one mild transient stroke followed the carotid artery surgery. No strokes occurred in the early postoperative period after the subsequent operations. Fifteen patients (44|X%) were asymptomatic six months to ton years (median, four years) following both the carotid artery surgery and a subsequent major surgical procedure. These data indicated that prophylactic carotid artery operations could be done in patients with multifocal atherosclerosis with a relatively low mortality rate and a low incidence of postoperative stroke. A randomized prospective study of surgical and nonsurgical management of asymptomatic patients with carotid arterial occlusive disease now is justified and is essential to precisely define the role of prophylactic surgery for these patients.