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February 3, 1969

Surgery for Cerebrovascular Insufficiency (Stroke): With Special Emphasis on Carotid Endarterectomy

Author Affiliations

University of Illinois Chicago

JAMA. 1969;207(5):956. doi:10.1001/jama.1969.03150180086039

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Analysis of 595 carotid artery operations in 466 patients leads to the conclusion that endarterectomy can increase cerebral blood flow and relieve manifestations of cerebral vascular insufficiency in many, but not all, cases. Differentiations are made between frank stroke (including reversible ischemic neurologic deficit), transient cerebral ischemia (no residues after 24 hours), and chronic cerebral ischemia. Emergency operation should not be done in the acute stage of profound stroke, rapidly progressing or rapidly improving stroke, if postoperative deaths are to be avoided. Total carotid occlusion may be operated on if the patient is seen in the first 6 to 12 hours. Patients with asymptomatic bruits may well be considered for angiography, and if significant lesions are found, endarterectomy may prevent future strokes. A final chapter considers briefly surgery of the aortic arch and vertebral vessels.

For the most part, the pictures are apropos and well reproduced. Technical details are not