The catastrophic nature of cerebral infarction is emphasized by its frequency, by a high death rate often cited as 15% to 25% and by a continued high attrition and incomplete rehabilitation of many survivors.1 It is now well known that extracranial vascular occlusive disease is a common cause of cerebral infarction and that this event is often heralded by premonitory neurologic symptoms. A large number of patients with such transient neurologic symptoms do have a completed stroke during subsequent years, the incidence rising with the length of follow-up.2
In the current issue of the Archives of Surgery, Perdue and co-authors3 emphasized that "by its very nature, carotid artery revascularization is preventive." Since morbidity and mortality are largely related to neurologic complications of the procedure, it is pertinent to consider the twin questions of safety and effectiveness of carotid revascularization as prophylactic surgery.
The factors adversely affecting safety