Abstract
Carotid endarterectomy (CE) was introduced very shortly after cerebral angiography identified the extracranial portion of the carotid artery as a common site responsible for stroke-threatening transient ischemic attacks (TIA). On the face of it, it was, and to many remains, as logical a surgical activity as the removal of an acoustic neuroma or the clipping of a saccular intracranial aneurysm. Why, then, has the procedure fallen afoul of universal acceptance? The reasons are several:
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1.
In the case of a ruptured aneurysm, the mortality, let alone the morbidity, from a recurrent hemorrhage is close to 50%. The survivors have almost an equal chance of being left with a serious disability. The TIA patient has at least a 90% chance of going through each successive year after the initial event(s) without a serious outcome.
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2.
If a stroke does occur, there is at least a 30% chance of its being in another arterial territory from that of the artery that caused the presenting symptoms.
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Barnett, H.J.M. (1991). Carotid Endarterectomy: A Challenge for Scientific Medicine. In: Norris, J.W., Hachinski, V.C. (eds) Prevention of Stroke. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-4226-8_14
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DOI: https://doi.org/10.1007/978-1-4757-4226-8_14
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