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September 1982

Prophylactic Carotid Endarterectomy for Asymptomatic BruitA Look at Cardiac Risk

Author Affiliations

From the Department of Surgery, Tufts-New England Medical Center, Boston.

Arch Surg. 1982;117(9):1222-1227. doi:10.1001/archsurg.1982.01380330080020

• We assessed the influence of preoperative cardiac risk factors in 57 patients undergoing 70 prophylactic carotid endarterectomies (PCE) and found that: (1) 47 (83%) had at least one cardiac risk factor and (2) nine of 15 deaths occurring in the late follow-up period (40 to 120 months) were due to cardiac causes. Perioperatively, one patient sustained a mild stroke. Although the cumulative stroke-free occurrence rate was kept to less than 6% over the five-year period, cardiac morbidity and mortality greatly influenced the quality of life after PCE. Therefore, PCE is suggested only for patients who have minimal preoperative cardiac risk factors or for those patients whose cardiac risk factors can be improved by medical therapy.

(Arch Surg 1982;117:1222-1227)

Baker WD:  The role of carotid endarterectomy . Vasc Diagn Ther 1981;2:19-24.
Cooperman M, Martin EW, Evans WE:  Significance of asymptomatic carotid bruits . Arch Surg 1978;113:1339-1340.Article
Kanaly P, Peyton M, Cannon JP, et al:  The asymptomatic bruit . Am J Surg 1977;134:821-824.Article
Wolf P, Kannel W, Sorlie P, et al:  Asymptomatic carotid bruit and risk of stroke: The Framingham study . JAMA 1981;245:1442-1445.Article
Levin SM, Sondheimer FK, Levin JM:  The contralateral diseased but asymptomatic carotid artery: To operate or not? An update . Am J Surg 1980;140:203-205.Article
Young JR, Santilli PH, Beven EG, et al:  Unoperated asymptomatic significant internal carotid artery stenosis: A review of 182 instances . Surgery 1976;80:695-698.
The Canadian Cooperative Study Group:  A randomized trial of aspirin and sulfinpyrazone in threatened stroke . N Engl J Med 1978;299:53-59.Article
Thompson JE:  Letter to the editor . N Engl J Med 1978;299:954.
Whisnant JP:  Letter to the editor . N Engl J Med 1978;299:953.Article
McBride K, Callow AD:  Recurrent stenosis after carotid endarterectomy: A limited survey , in Bernhard VM, Towne JB (eds): Complications in Vascular Surgery . New York, Grune & Stratton Inc, 1980, pp 259-272.
Callow AD:  The Leriche memorial lecture: Fact or fancy: A 20 year personal perspective on the detection and management of carotid occlusive disease . J Cardiovasc Surg 1980;21:641-658.
Thompson JE, Austin DJ, Patman RD:  Carotid endarterectomy for cerebrovascular insufficiency: Long-term results in 592 patients followed up to 13 years . Ann Surg 1970;172:663-678.Article
Thompson J, Patman RD, Talkington CM:  Asymptomatic carotid bruit: Long-term outcome of patients having endarterectomy compared with unoperated controls . Ann Surg 1978;188:308-316.Article
Callow AD, Matsumoto G, Baker D, et al:  Protection of the high risk carotid endarterectomy patient by continuous electroencephalography . J Cardiovasc Surg 1978;19:55-64.
Gaal PG, Wong D:  The current status of prophylactic carotid endarterectomy . Am Surg 1964;30:415-419.
Heyman A, Wilkinson W, Heyden S, et al:  Risk of stroke in asymptomatic persons with cervical arterial bruits . N Engl J Med 1980;302:838-841.Article
Moore W, Boren C, Malone J, et al:  Asymptomatic carotid stenosis . Am J Surg 1979;138:228-233.Article
Bauer RB, Meyer JS, Fields WS, et al:  Joint study of extracranial arterial occlusion . JAMA 1969;208:509-518.Article
Salem D, Homans D, Isner J:  Management of cardiac disease in the general surgical patient . Curr Probl Cardiol 1980;5:23-25.Article
Lefrak EA, Guinn GA:  Prophylactic carotid artery surgery in patients requiring a second operation . South Med J 1974;67:185-189.Article
Javid H, Ostermiller W, Hengesh J, et al:  Carotid endarterectomy for asymptomatic patients . Arch Surg 1971;102:389-391.Article
Busuttil R, Baker JD, Davidson RK, et al:  Carotid artery stenosis: Hemodynamic significance and clinical course . JAMA 1981;245:1438-1441.Article
Kartchner MM, McRae LP:  Non-invasive evaluation and management of the 'asymptomatic' carotid bruit . Surgery 1977;82:840-847.
Easton JD, Sherman DG:  Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations . Stroke 1977;8:565-568.Article
Goldman L, Caldera D, Nussbaum S, et al:  Multifactorial index of cardiac risk in noncardiac surgical procedures . N Engl J Med 1977;297:845-850.Article
Heller JN, Salem D, Isner JM, et al: A prospective comparison of Goldman criteria to isotope angiocardiography in the preoperative cardiac assessment of the vascular patient. J Cardiovasc Surg, in press.