抄録
The indications for prophylactic carotid endarterectomy (CEA) in patients with asymptomatic stenosis of the extracranial internal carotid (IC) artery remain controversial. Indications in our service are as follows: a greater than 50% reduction in carotid artery diameter (hemodynamic factor) and ulceration (embolic factor); and as shown with angiography intraplaque hemorrhage or ulceration as shown with ultrasonography. Over a 15-year period (1975-1990), 44 CEAs were performed on 41 patients with asymptomatic extracranial IC stenosis. Two of the patients died, one due to intracerebral hemorrhage that was thought to be hyperperfusion syndrome and one due to myocardial infarction. None of the other patients displayed permanent neurological deficit. Therefore, the perioperative mortality and morbidity rate was 4.5%. During postoperative follow-up (4 mo-15 yr mean 5.6±4.0 yr), five patients died, one due to cerebral infarction, one due to cerebral hemorrhage and three due to cardiac diseases. Since none of the other patients died of stroke, the stroke and death rates were 2.3%/yr. In this series, the perioperative mortality and morbidity rate was slightly high, but in the recent five-year follow-up (18 CEAs) there were no strokes or deaths. The reason for the good results may have been the use of systematic check-up on cardiac function (cardiac sonography, coronary angiography) and other risk factors (hypertension, hyperlipidemia, hypercoagulability, hyperaggregability, hyperviscosity, etc.). In conclusion, if hazardous asymptomatic lesions are demonstrated, prophylactic CEA may be performed with minimal mortality and morbidity by careful pre- and postoperative managements.
