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November 1982

Natural History of Nonstenotic, Asymptomatic Ulcerative Lesions of the Carotid Artery: A Further Analysis

Author Affiliations

From the Departments of Surgery (Drs Dixon, Raviola, Machleder, Baker, Busuttil, Barker, and Moore) and Radiology (Drs Pais and Gomes), UCLA School of Medicine.

Arch Surg. 1982;117(11):1493-1498. doi:10.1001/archsurg.1982.01380350079011

• The natural history of 153 asymptomatic, nonstenotic ulcerative lesions of the carotid bifurcation in 141 patients was reviewed. A technique for quantitatively defining small (A), large (B), and compound (C) ulcers was developed. During the course of study, extending up to ten years, 3% of patients with A ulcers, 21% with B ulcers, and 19% with C ulcers had hemispheric strokes without antecedent transient ischemic attacks (TIAs), on the side appropriate to the lesion. The interval annual stroke rate was 4.5% for B ulcers and 7.5% for C ulcers. Because these interval stroke rates are comparable to the 6% annual stroke rate occurring in patients with TIAs, a well-accepted indication for operation, we recommend prophylactic operation for these lesions in good surgical candidates, to be performed by surgeons who have demonstrably low operative stroke rates.

(Arch Surg 1982;117:1493-1498)