THE TREATMENT OF PATIENTS WITH CAROTID ST ENOSIS IN 1993 - INDICATIONS AND LONG-TERM RESULTS OF SURGERY

Cerebrosvascular accidents (CVAs) are the third commonest cause of dea th in France. Approximately 15 % of them are due to stenosis of the ex tracranial internal carotid. The fact that a third of CVAs are followe d by death and another third by major handicaps leads to the need for careful prevention. This has three aspects: 1) Correction of risk fact ors: hypertension, smoking hyperglycemia, hyperlipidemia, obesity, alc ohol abuse, hematological abnormalities and oral contraception; 2) the prescription of one of two platelet anti-aggregants, the efficacy of which has been proved: acetylsalicylic acid or ticlopidine; 3) surgica l elimination of tight carotid stenoses. The following require surgery : 1) more than 70 % stenosis following cerebral or ocular TIA or minor CVA; 2) more than 75 % stenosis in asymptomatic patients or with epis odes of VBI as well as 70 % in case of thrombosis of the contralateral internal carotid; 3) following a CVA leaving serious sequelae: tight stenosis when it is reasonable to assume that a further CVA could lead to clinical worsening or to a loss of independence; 4) symptomatic an d/or more than 80 % restenosis. The decision should be made only after confirmation of the diagnosis and of the degree Of stenosis and verif ication of the absence of any local or systemic contra-indication. The surgical team must have a low cumulative mortality and perioperative CVA rate. These patients require ongoing medical monitoring, particula rly from a cardiological standpoint.