Annals of Vascular Surgery

, Volume 8, Issue 2, pp 144–149 | Cite as

Immediate and long-term results of carotid endarterectomy for asymptomatic high-grade stenosis

  • Thomas S. Riles
  • Frederick S. Fisher
  • Patrick J. Lamparello
  • Gary Giangola
  • Lee Gibstein
  • Ronnie Mintzer
  • William T. Su
Original Articles


We examined the operative risks and long-term results of carotid endarterectomy for asymptomatic patients in terms of stroke, death, and recurrent stenosis. The results of a nonrandomized study with a follow-up of 1 to 104 months (mean 46 months) is reported. A tertiary referral center served as the setting for this report. One hundred consecutive patients with severe but asymptomatic carotid artery stenosis out of a total of 514 patients undergoing carotid endarterectomy were entered into this study. The severity of carotid disease was determined by duplex scanning and confirmed arteriographically. No patients were lost to follow-up after surgery. Eighty-nine operations (77%) were done under cervical block anesthesia and all arteries were closed with saphenous vein patches. Life-table analysis showed that the stroke-free rate at 5 years was 96.3% with an ipsilateral stroke-free rate of 98.2%. The 5-year overall survival rate was 78.2% with a stroke-free survival rate of 75%. Carotid endarterectomy can be performed safely for asymptomatic patients believed to be at risk for stroke. The potential for early death due to myocardial disease, late stroke, and recurrent stenosis do not justify advising patients against undergoing prophylactic carotid endarterectomy for asymptomatic high-grade stenosis.


Asymptomatic Patient Saphenous Vein Carotid Endarterectomy Tertiary Referral Center Asymptomatic Carotid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patient with high-grade stenosis. N Engl J Med 1991;325:445–453.CrossRefGoogle Scholar
  2. 2.
    European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial: Interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 1991;337:1255–1256.Google Scholar
  3. 3.
    Wolf PA, Kannel WB, Sorlie P, et al. Asymptomatic carotid bruit and risk of stroke: The Framingham Study. JAMA 1981;245:1442–1445.CrossRefPubMedGoogle Scholar
  4. 4.
    Kartchner MM, McRae LP. Noninvasive evaluation and management of the asymptomatic carotid bruit. Surgery 1977;82:840–947.PubMedGoogle Scholar
  5. 5.
    Bogousslavsky J, Despland PA, Regli F. Asymptomatic tight stenosis of internal carotid artery: Long-term progress. Neurology 1986;36:861–863.PubMedGoogle Scholar
  6. 6.
    Chambers BR, Norris JW. The case against surgery for asymptomatic carotid stenosis. Stroke 1984;15:964–967.PubMedGoogle Scholar
  7. 7.
    Hennerici M, Hulsbomer MB, Hefter H, et al. Natural history of asymptomatic extracranial arterial disease. Brain 1987;10:777–791.Google Scholar
  8. 8.
    Moore DJ, Miles RD, Gooley NA, et al. Noninvasive assessment of stroke risk in asymptomatic and nonhemispheric patients with suspected carotid disease. Ann Surg 1985;202:491–504.PubMedGoogle Scholar
  9. 9.
    Roederer GO, Langlois YE, Jager KA, et al. The natural history of carotid arterial disease in asymptomatic patients with cervical bruits. Stroke 1984;15:605–613.PubMedGoogle Scholar
  10. 10.
    Moneta GL, Taylor DC, Nicholls SC, et al. Operative vs. nonoperative management of symptomatic high-grade internal carotid artery stenosis: Improved results with endarterectomy. Stroke 1987;18:1005–1010.PubMedGoogle Scholar
  11. 11.
    Humphries AW, Young JR, Santilli PH, et al. Unoperated asymptomatic significant internal carotid artery stenosis: A review of 182 instances. Surgery 1976;80:695–698.PubMedGoogle Scholar
  12. 12.
    Thompson JE, Patman RD, Talkington CM. Asymptomatic carotid bruits: Long-term outcome of patients having endarterectomy compared with unoperated controls. Ann Surg 1978;188:308–316.PubMedGoogle Scholar
  13. 13.
    Moore WS, Boren C, Malone JM, et al. Natural history of nonstenotic symptomatic ulcerative lesions of the carotid artery. Arch Surg 1978;113:1352–1359.PubMedGoogle Scholar
  14. 14.
    Podore PC, DeWeese JA, May AG, et al. Asymptomatic contralateral carotid artery stenosis: A five-year follow-up study following carotid endarterectomy. Surgery 1980;88:748–752.PubMedGoogle Scholar
  15. 15.
    Durward OF, Ferguson GG, Barr HKW. The natural history of asymptomatic carotid bifurcation plaques. Stroke 1982;13:459–464.PubMedGoogle Scholar
  16. 16.
    Meissner I, Wiebers DO, Whisnant JP, et al. The natural history of asymptomatic carotid artery occlusive lesions. JAMA 1987;258:2704–2707.CrossRefPubMedGoogle Scholar
  17. 17.
    Caracci BF, Zukowski AJ, Hurley JJ, et al. Asymptomatic severe carotid stenosis. J Vasc Surg 1989;9:361–366.PubMedGoogle Scholar
  18. 18.
    Hertzer NR, Flanagan RA, Beven EG, et al. Surgical versus nonoperative treatment of asymptomatic carotid stenosis. 290 patients documented by intravenous angiography. Ann Surg 1986;204:163–171.PubMedCrossRefGoogle Scholar
  19. 19.
    Hobson RW, Weiss DG, Fields WS, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med 1993;328:221–227.CrossRefPubMedGoogle Scholar
  20. 20.
    Towne JB, Weiss DG, Hobson RW. First phase report of cooperative Veterans Administration asymptomatic carotid stenosis study—operative morbidity and mortality. J Vasc Surg 1990;11:252–259.CrossRefPubMedGoogle Scholar
  21. 21.
    Freischlag JA, Hanna O, Moore WS. Improved prognosis for asymptomatic carotid stenosis with prophylactic carotid endarterectomy. Stroke 1992;23:479–482.PubMedGoogle Scholar

Copyright information

© Annals of Vascular Surgery Inc. 1994

Authors and Affiliations

  • Thomas S. Riles
    • 1
  • Frederick S. Fisher
    • 1
  • Patrick J. Lamparello
    • 1
  • Gary Giangola
    • 1
  • Lee Gibstein
    • 1
  • Ronnie Mintzer
    • 1
  • William T. Su
    • 1
  1. 1.Department of SurgeryNew York University Medical CenterNew York

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