Current Concepts of Cerebrovascular Disease -- Stroke: A New Look at Emergency Carotid Artery Operations for the Treatment of Cerebrovascular Insufficiency

CAROTID ARTERY bifurcation endarterectomy is now well established in the treatment of patients with monocular or hemispheric transient cerebral ischemic attacks. Conversely, it is also thought that carotid surgery is contraindicated for patients with acute severe strokes because of the risk of making the neurological deficit worse. However, a small percentage of patients have thromboembolic cerebral ischemia manifested by unstable neurological deficits of only mild to moderate degree. There is no consensus on the approach to these patients, but many neurologists and vascular surgeons have considered them as acute strokes and avoided angiography and surgery. Dissatisfied with the outcome in several such patients treated in this manner, we have recently adopted a more aggressive plan of management. The purpose of the present report is to describe this approach and the successful results of its use.

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