Indication for Carotid Endarterectomy based on Outcome of 65 Cases with Symptomatic Extracranial Carotid Stenosis

To re-evaluate the angiographic indications for carotid endarterectomy (CEA) in the presence of symptomatic internal carotid artery stenosis, the authors followed 65 patients clinically and angiographically for periods of 3 to 5 years. Twenty-six patients underwent CEA and 39 were treated without CEA. They were divided into eight groups according to degree of stenosis and existence of wall irregularity on the initial angiogram. In each group, differences in outcome in patients treated with and without CEA were investigated. The development of symptoms was accompanied by disease progression in six patients treated without CEA. In each of these six cases, more than 50% stenosis and wall irregularity were observed on the initial angiogram, and disease progression was confirmed on the subsequent angiogram. It can be concluded that, in patients with symptomatic internal carotid artery stenosis, the angiographic indications for CEA are more than 75% stenosis with or without wall irregularity, and 50-75% stenosis with wall irregularity.