Original Articles from the New England Society for Vascular SurgeryLate stroke after carotid endarterectomy: The role of recurrent stenosis*
Section snippets
Methods
The carotid registry at Tufts-New England Medical Center contains complete data on 688 patients who have undergone at least one carotid endarterectomy at our institution between 1961 and 1987 and for whom current or determinant follow-up data are available. Follow-up data are updated at the time of regular office visits or, when necessary, by periodic telephone interview or mailed questionnaire. Registry methods are more fully described in an earlier publication.1
For patients coded as suffering
Results
The 688 patients in our registry underwent 1015 carotid endarterectomies. There were 20 perioperative strokes (2.9% patient-specific incidence and 2.0% operation-specific incidence). There were 35 late strokes (5.1% incidence). Earlier reports based on our registry data suggested a higher incidence of late stroke (44 of 597, 7.4% in patients for whom angiographic data could be retrieved).7 Under scrutiny of the more detailed review carried out in this study, however, several events were
Discussion
Late stroke occurs in 5% to 13% of patients undergoing carotid endarterectomy, and the crude postendarterectomy stroke incidence (including perioperative strokes) is 1.6% to 3% annually. 1, 8, 9, 10 The annual stroke rate for all persons 55 to 64 years is 0.29%, for those 65 to 74 years it is 0.55%, and for those 75 to 84 years it is 1.2%.11 Thus despite the proven efficacy of carotid endarterectomy in stroke prevention in selected patients, after patients have had endarterectomy they are 1.3
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Reprint requests: William C. Mackey, MD, Box 1035, New England Medical Center, 750 Washington St., Boston, MA 02111.