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November 1978

Results of Carotid Endarterectomy for Vertebrobasilar InsufficiencyAn Evaluation Over Ten Years

Author Affiliations

From the Vascular Service, Department of Surgery, Tufts-New England Medical Center, and the Department of Surgery, Tufts University School of Medicine, Boston.

Arch Surg. 1978;113(11):1361-1364. doi:10.1001/archsurg.1978.01370230151019

• A review was performed of 114 patients with symptoms of vertebrobasilar insufficiency (VBI) alone, or in combination with carotid territory transient ischemic attacks or carotid territory completed stroke (cCS) with follow-up extending to ten years. The most frequent symptoms of VBI were visual changes (50%), dizziness (31%), and syncope (30%). Patients with symptoms of VBI and arteriographic evidence of intracranial disease, regardless of stump pressure, are at high risk for cerebral ischemia during endarterectomy. At late follow-up, ranging from one to ten years, 63% of the patients were alive; 88% were asymptomatic. Causes of death were mainly cardiac (44%)and stroke (36%), but patients with symptoms of VBI and cCS died earlier and from a second cerebrovascular accident. When a correct preoperative diagnosis was established, carotid endarterectomy produced relief of symptoms in 90% of the patients.

(Arch Surg 113:1361-1364, 1978)