Evaluation of the neurological risk of asymptomatic carotid stenosis and discussion of the value of carotid surgery in stage 0. Apropos of a study of 123 obliterative lesions

: The authors analyzed neurological risk on the basis of the study of 123 asymptomatic obstructive carotid lesions. Patients were divided into two groups: Group A (54 patients undergoing prophylactic endarterectomy). Group B (69 patients not undergoing surgery). Definition of the carotid lesion was based upon a combination of Doppler, sonography and arteriography results. Assessment of comparative neurological risk, on the basis of a hemodynamic definition of the stenosis, in the two patient groups, led to definition of appropriate management of an asymptomatic carotid stenosis. In group A, operative mortality was nil and there was one transient ischemic accident. In group B, there were 12 accidents, 9 transient and 3 permanent. In this latter group there was one neurological death, i. e. mortality of neurological origin of 1.5%. Evaluation of risk initially requires definition of the stenosis. The presence of a carotid bruit alone is inadequate. Doppler and sonography, followed where necessary by arteriography, define the degree of stenosis which is the primordial prognostic feature. The difference of risk between a population undergoing surgery or not is statistically significant, in particular in hemodynamically tight stenosis. Finally, the degree of stenosis influences the severity of any subsequent accident, although this has not been proved statistically. In the majority of cases, the initial accident would appear to be regressive. In total, 4 concepts have been defined: the risk of carotid surgery at stage 0 is low, being of the order of 0. Overall neurological risk is less in the long term in asymptomatic patients who have undergone surgery than in those who have not been operated upon.(ABSTRACT TRUNCATED AT 250 WORDS)