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April 10, 1981

Carotid Artery Stenosis—Hemodynamic Significance and Clinical Course

Author Affiliations

From the Department of Surgery, Section of Vascular Surgery, University of California School of Medicine, The Center for the Health Sciences, Los Angeles (Drs Busuttil and Machleder and Ms Davidson), and the Department of Surgery, Sepulveda Veterans Administration Hospital, Sepulveda, Calif (Dr Baker).

JAMA. 1981;245(14):1438-1441. doi:10.1001/jama.1981.03310390038018

Two hundred fifteen patients with a history of either stroke, transient ischemic attack (TIA), or asymptomatic carotid bruit underwent noninvasive carotid artery testing using oculopneumoplethysmography. Of patients with hemodynamically significant stenosis, 51 (40.8%) underwent endarterectomy, and 74 (59.2%) were treated nonoperatively. The incidence of stroke in the nonoperated group was 12/74 (16.2%) compared with only 1/51 (1.9%) in the operated group. Similarly, recurrent TIA occurred in 29/74 (39.2%) of the nonoperated group vs 9/51 (17.6%) of the operated. In nonhemodynamically significant carotid stenosis, the risk of cerebrovascular death and stroke was exceedingly low: 2/90 (2.2%). Patients with hemodynamically significant stenosis treated nonoperatively have a greater risk of cerebrovascular death, stroke, and TIA than patients treated with carotid endarterectomy.

(JAMA 1981;245:1438-1441)