Comparative risk of operation and expectant management for carotid artery disease.

Although it has been shown that patients who undergo successful carotid endarterectomy without permanent neurologic morbidity have a significantly decreased risk of stroke compared to similar patients managed medically, the decision to recommend operation remains controversial for many clinicians. In part, this controversy is based upon the variability of surgical results. Review of the surgical literature for carotid endarterectomy for 1968 through 1977 shows that the average incidence of perioperative stroke and death is 9.1%. However, the surgical results show a range in permanent neurologic morbidity from 0.8% to 27%, and a range in surgical mortality from 0% to 11.2%.