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Article
November 1978

Natural History of Nonstenotic, Asymptomatic Ulcerative Lesions of the Carotid Artery

Author Affiliations

From the Department of Surgery (Drs Moore and Malone), University of Arizona, Tucson, and the Department of Surgery (Drs Boren, Roon, and Goldstone) and Radiology (Drs Eisenberg and Mani), Veterans Administration Hospital, University of California, San Francisco.

Arch Surg. 1978;113(11):1352-1359. doi:10.1001/archsurg.1978.01370230142018
Abstract

• To define the natural history of the asymptomatic, nonstenotic, ulcerative lesion involving the carotid artery bifurcation, the arteriograms and clinical course of 67 patients with 72 asymptomatic ulcerative lesions of the carotid artery were reviewed. The angiographic appearance of ulceration was classified into three groups: minimal (group A), large (group B), and compound (group C).

Using life-table methods, the clinical course of these patients was compared between groups and was also compared to a nonrandomized surgically treated group of patients with nonstenotic ulcerative lesions in whom operation was performed for hemispheric or monocular symptoms.

There were no significant (P >.1) differences in mortality, but the differences in stroke incidence was highly significant (P <.001). The annual stroke rate, averaged over seven years, was 0.4% per year for group A, 1.47% per year for the surgically treated group, and 12.5% per year for groups B and C. The data indicate that group A ulcers have a benign prognosis, in noticeable contrast to group B and C ulcers which incur a high risk for subsequent stroke.

(Arch Surg 113:1352-1359, 1978)

References
1.
Moore WS, Hall AD:  Ulcerated atheroma of the carotid artery: A cause of transient cerebral ischemia . Am J Surg 116:237-242, 1968.Article
2.
Moore WS, Hall AD:  Importance of emboli from carotid bifurcation in pathogenesis of cerebral ischemia attacks . Arch Surg 101:708-716, 1970.Article
3.
Maddison FE, Moore WS:  Ulcerated atheroma of the carotid artery: Arteriographic appearance . AJR 107:530-534, 1969.Article
4.
Javid H, Ostermiller W, Hengesh JW, et al:  Carotid endarterectomy for asymptomatic patients . Surgery 102:289-391, 1971.
5.
Thompson JE, Austin DJ, Patman RD:  Carotid endarterectomy for cerebrovascular insufficiency: Long-term results in 592 patients followed up to 13 years . Ann Surg 172:663-679, 1970.Article
6.
Thompson JE, Patman RD:  Endarterectomy for asymptomatic carotid bruits . Surg Digest 7:9-14, 1972.
7.
Levin SM, Sondheimer FK:  Stenosis of the contralateral, asymptomatic carotid artery–to operate or not? Vasc Surg 7:3-13, 1973.Article
8.
Thompson JE, Talkington CM:  Carotid endarterectomy . Ann Surg 184:1-15, 1976.Article
9.
Humphries AW, Young JR, Santilli PH, et al:  Unoperated, asymptomatic significant internal carotid artery stenosis: A review of 182 instances . Surgery 80:695-698, 1976.
10.
Eisenberg R, Nemzek WR, Moore WS, et al:  Relationship of transient ischemic attacks and angiographically demonstrable lesions of carotid artery . Stroke 8:483-486, 1977.Article
11.
Fisher CM:  Observations of the fundus oculi in transient monocular blindness . Neurology 9:333-347, 1959.Article
12.
Hollenhorst RW:  Significance of bright plaques in the retinal arterioles . JAMA 178:23, 1961.Article
13.
Julian OC, Dye WS, Javid H, et al:  Ulcerative lesions of the carotid artery bifurcation . Arch Surg 86:803-809, 1963.Article
14.
Ehrenfeld WK, Hoyt WF, Wylie EJ:  Embolization and transient blindness from carotid atheroma . Arch Surg 93:787-794, 1966.Article
15.
Gunning AJ, Pickering GW, Robb-Smith AHT, et al:  Mural thrombosis of the internal carotid artery and subsequent embolism . Q J Med 33:155-195, 1964.
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