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PubMed1992

Bilateral severe carotid stenosis or occlusion and computed tomographic scan positive hemispheric stroke with neurologic deficit: immediate contralateral carotid endarterectomy.

In the last 10 years, 13 patients presented with acute, hemispheric, computed tomographic scan-positive stroke; neurologic deficit; and bilateral carotid stenosis greater than 90% (N = 9) or ipsilateral occlusion with contralateral stenosis greater than 90% (N = 4). To improve ipsilateral flow without elevation of pressure to levels causing hemorrhagic infarction, all patients underwent carotid endarterectomy on the side contralateral to the hemispheric stroke from two to 10 days (average 6.6 days) from onset of symptoms. Those with fluctuating deficits stabilized to the initial fixed deficit and all 13 improved over the next six months. Four patients with ipsilateral internal carotid occlusion and one with ipsilateral severe siphon stenosis were discharged on antiplatelet therapy; of the remaining eight patients, seven underwent subsequent ipsilateral carotid endarterectomy from 42 to 111 days (average 58.4 days) from onset of symptoms. Mortality and stroke rate were 0. The four patients with internal carotid occlusion and the one with severe siphon stenosis filled both hemispheres from the contralateral carotid artery arteriographically in four and by oculoplethysmography in one. One patient demonstrated preferential flow from contralateral to the ipsilateral hemisphere, but not the reverse; one patient demonstrated pericallosal collaterals. Immediate endarterectomy of the severely diseased carotid artery contralateral to a hemisphere with a computed tomographic scan-positive stroke causing neurologic deficit resulting from a severe carotid stenosis is a safe treatment option and may be beneficial in those with fluctuating neurologic deficits.

Aged↗
PubMed1993

Does carotid eversion endarterectomy and reimplantation reduce the risk of restenosis?

Two hundred twelve eversion endarterectomies of the internal carotid artery and reimplantation in the common carotid artery were performed between January 1985 and July 1990. A total of 206 patients with stenosis of 75% or more and with redundancy and tortuosity of the internal carotid artery underwent this procedure. Cumulative mortality and neurologic morbidity were 2.4%. Forty patients died during the course of follow-up, seven of neurologic causes (17.1%). Duplex scans of 107 operated carotid arteries were obtained an average of 27.1 months after surgery. Restenosis of > 50% was encountered in three patients (1.9%), two asymptomatic patients (1.3%) with > 75% restenosis and one symptomatic patient with occlusion (0.6%). These results contrast with a 13.5% rate of restenoses > 50% (including 5.9% of restenoses > 75% and 1.7% occlusions) observed after 156 consecutive endarterectomies performed and closed by direct suture by the same surgical team in 1987 at a mean follow-up of 44 months. We believe that this technique can be used more often because the the operative and long-term risks are not any greater than those of the other methods of carotid revascularization. Eversion endarterectomy associated with reimplantation is especially indicated when the internal carotid artery is elongated, is < 4 mm wide, and occurs in women.

Aged↗
PubMed1990

Safety and long-term benefit of carotid endarterectomy in the asymptomatic patient.

In order to determine the safety and long-term salutary effects of carotid endarterectomy in the asymptomatic patient, we retrospectively reviewed all asymptomatic patients who underwent carotid endarterectomy from 1980 through 1986. There were 60 carotid endarterectomies performed in 54 patients, 53 men and one woman. The mean age was 64 years. Arteriography revealed a high grade stenosis of 70% or greater in 46 carotid arteries (77%), ulceration in five (8%), and both in nine (15%). Risk factors included coronary artery disease in 60% of patients, smoking in 87%, hypertension in 67%, and diabetes in 22%. Perioperative morbidity included three cranial nerve injuries, one myocardial infarction and one contralateral stroke. There were no deaths. Mean follow-up was 47 months with only two patients being lost to follow-up. During follow-up three patients suffered ipsilateral transient ischemic attacks without recurrent carotid stenosis and one patient had a transient ischemic attack secondary to contralateral carotid occlusion. There was one ipsilateral stroke occurring two years after operation secondary to restenosis that required reoperation and four late contralateral strokes. Ten patients died in the follow-up period. Causes of death were stroke (1), cardiac (4), malignancy (2), pulmonary (2), and unknown (1). All surviving patients were evaluated by duplex scan at a mean interval following surgery of 47 months. Restenosis of endarterectomized arteries was seen at the following rates: less than 50% in 41 (87%); 50-75% in four (8.5%); 80% in one (2%); and 90% in one (2%). Life table analysis revealed a 98% ipsilateral stroke-free rate at five and eight years.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1995

A comparative study of saphenous vein, internal jugular vein, and knitted Dacron patches for carotid artery endarterectomy.

To determine whether the choice of material used for patch closure following carotid artery endarterectomy (CAE) affected the immediate operative results, the early follow-up results, or the incidence of early restenosis, a retrospective study of 275 consecutive carotid endarterectomies by two vascular surgeons was performed. Among 275 primary CAEs performed between July 1991 and August 1993, 159 (57.8%) were closed with saphenous vein (SV), 25 (9.1%) with double-thickness internal jugular vein (JV), and 91 (33.1%) with knitted Dacron (KD). Primary closure was not used in any of the arteries in this series. The overall perioperative mortality rate was 1.1% and the rate of major and minor morbidity was 4.4% There were four (1.5%) perioperative strokes: two (1.3%) in the SV group, one (4.0%) in the JV group, and one (1.1%) in the KD group. Two-hundred fifty-eight (93.8%) of the 275 endarterectomies were followed postoperatively for 2 to 35 months (mean 14.4). Two-hundred nineteen (79.6%) were evaluated using duplex scans during follow-up with a mean interval of 13.7 months. Of the arteries studied, four (3.6%) in the SV group, none in the JV group, and six (8.4%) in the KD group demonstrated restenosis of > 50% at the time of follow-up (NS). In addition, one (0.9%) artery in the SV group, one (5.6%) in the JV group, and none in the KD group demonstrated complete occlusion. Retrospective analysis of the data showed no statistically significant differences in perioperative morbidity, mortality, or early postoperative restenosis whether the artery was closed with saphenous vein, jugular vein, or knitted Dacron patches. Longer follow-up is needed to determine whether rates of late restenosis and aneurysmal dilation will differ between synthetic and autologous patches.

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PubMed1991

Carotid endarterectomy for asymptomatic carotid stenosis: a ten-year experience with 120 procedures in a fellowship training program.

Performance of carotid endarterectomy for asymptomatic carotid stenosis has been restricted during recent years because of concern of reported complications in as high as 10-15% of patients, as well as limited long-term data on stroke protection. During the last 10 years, we have studied immediate and long-term results of carotid endarterectomy for asymptomatic disease in 120 patients. Operations were performed by a clinical vascular fellow with a staff surgeon in attendance in 113 (94%) cases with the remainder performed by the staff surgeon. Patients' mean age was 66 years; 82% were men. Risk factors included hypertension (56%), smoking (52%), coronary artery disease (32%), diabetes (24%), and hypercholesterolemia (6%). Arteriographic severity of stenoses was 80-99% in 74%, 60-79% in 22%, and 40-59% in 4% of cases. Postoperative complications included two transient neurological events (1.7%). No permanent strokes or deaths occurred. Using the life table method, cumulative stroke rate was 4.5% for ipsilateral events and 7.3% for contralateral events, confirming the high degree of stroke protection afforded by carotid endarterectomy in this population. Since these results were accomplished in a fellowship training program, we regard adequacy of this experience as the most influential factor in accomplishing this record. Surgeons who are unable to achieve comparable results should consider abandonment of the procedure or an extended period of additional training.

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PubMed1991

A technique for correction of carotid kinks and coils following endarterectomy.

This study presents a technique to correct kinking or coiling of the internal carotid artery using patch angioplasty following endarterectomy, resection, and anastomoses of the vessel. Since 1984, 579 carotid endarterectomies have been performed with 19 patients (3.3%) having arteriosclerotic carotid bulb and internal carotid artery disease associated with a carotid kink or coil. These have been treated successfully using the technique of resection and patch angioplasty. The indications for surgery included seven patients with transient ischemic attacks (36.8%); seven patients who had suffered a cerebrovascular accident (36.8%); amaurosis fugax in two patients (10.5%); and one patient each with Hollenhorst plaque (5.3%), central retinal artery occlusion (5.3%), and an asymptomatic critical stenosis (5.3%). All patients had successful repair of the vessel using saphenous vein or Dacron patch angioplasty. There were no perioperative strokes or deaths. Follow-up ranged from four months to 58 months (mean 25 months). All vessels are patent with no evidence of stenosis. One patient had an ipsilateral cerebrovascular accident but had no evidence of recurrent carotid disease. Surgical correction of the carotid kink or coil can present a difficult surgical problem, and resection, fixation, or transposition can be complicated. The technique of endarterectomy, resection of the redundant vessel with anastomosis of the back wall, and patch angioplasty has been used effectively and safely in this series of patients.

Anastomosis, Surgical↗
PubMed1993

Neurologic events following carotid endarterectomy: prediction of outcome.

A total of 1572 carotid endarterectomies were performed at one institution between 1975 and 1987. One hundred five patients had early (< 3 weeks) neurologic events following carotid endarterectomy. Sixty-five patients had cerebral vascular accidents (CVAs) (4.1%), 14 patients had reversible ischemic neurologic deficits (0.9%), and 26 patients had transient ischemic attacks (1.7%). Eight patients died from CVAs (0.5%). The mean follow-up was 31 months (range 1 to 137 months) with a 5-year cumulative survival of 77%. The median time of occurrence of neurologic events was 4 hours. Ages, cerebral protection, patches, carotid occlusion time (mean 29 minutes), gender, and status of the contralateral carotid arteries were not predictors of outcome. Death from neurologic events increased significantly in patients who had preoperative CVAs compared with patients with preoperative transient neurologic deficits (p < 0.05). The time of occurrence of CVA after carotid endarterectomy affected outcome, and an early CVA (< 4 hours) was associated with a higher mortality at 30 days and at 4 months as a consequence of the initial CVA (p = 0.11). Patients who had a neurologic event more than 4 hours after surgery had a significantly better resolution of their symptoms (66%) compared with patients who had an early neurologic event (35%, p < 0.05). The long-term follow-up of the surviving patients demonstrated an improvement in neurologic function in 75% of the CVA group (36/48) and 92% (76/83) of all patients who had neurologic events in long-term follow-up.

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PubMed1993

Continuous transcranial Doppler ultrasonography and electroencephalography during carotid endarterectomy: a multimodal monitoring system to detect intraoperative ischemia.

Transcranial Doppler ultrasonography (TCD) and EEG monitoring during carotid endarterectomy provide continuous information on the electrical activity of the cerebral cortex, blood flow velocities in the ipsilateral middle cerebral artery, and the occurrence of microemboli. One hundred thirty carotid endarterectomies performed with TCD and EEG monitoring were studied prospectively. During cross-clamping of the carotid artery a high correlation was found between EEG asymmetry and reduction of blood flow velocity in the middle cerebral artery (p < 10(-6), Student's t test). Microemboli were detected in 80 patients during the operation. Although not statistically significant, this occurrence of microemboli was associated with signs and symptoms of intraoperative ischemia (p = 0.08, Fisher's exact test). In comparison with earlier studies, a tendency toward intraoperative stroke reduction was noted. Only one nondisabling intraoperative stroke occurred (0.8%). In addition to the EEG, TCD monitoring of hemodynamic changes and microemboli in the middle cerebral artery provides important information to the surgeon instantaneously. TCD monitoring of blood flow velocities and embolism during carotid endarterectomy may help to reduce the number and gravity of intraoperative stroke.

Adult↗
PubMed1994

Carotid endarterectomy in the octogenarian.

During a 10-year period from January 1983 to December 1992, 79 carotid endarterectomies were performed in patients aged 80 years or older. This represented 7.4% of the total patient population undergoing carotid endarterectomy at Emory University Hospital. The indications for surgery in this elderly population were transient ischemic attacks in 24 (30.3%), cerebrovascular accident in 12 (15.2%), amaurosis fugax in seven (8.9%), vascular tinnitus in one (1.3%), and asymptomatic stenosis in 35 (44.3%). The average degree of ipsilateral stenosis was 76.8%. Concomitant risk factors included coronary artery disease in 43%, systemic arterial hypertension in 51.9%, diabetes mellitus in 10.1%, and significant smoking history in 53.2%. Seventy-six percent of the procedures were performed under local anesthesia, and in all but two intraluminal shunts were used. Combined 30-day mortality and postoperative stroke morbidity in this population was 1.3% (one patient). Long-term follow-up ranging from 1 to 10 years (average 35 months) revealed no ipsilateral strokes. This experience suggests that carotid endarterectomy can be performed in an elderly population with morbidity and mortality rates similar to those in a younger cohort.

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PubMed1995

Eversion endarterectomy of the internal carotid artery: midterm results of a new technique.

A new eversion endarterectomy technique was used in 65 internal carotid artery reconstructions in 56 patients. The original features of the technique include a complete oblique transection of the internal carotid artery distal to the lesion and eversion endarterectomy through a longitudinal incision of the common carotid and external carotid arteries. The mean age of the patients was 68.2 +/- 7.8 years. Seventy-three percent of the patients had hypertension and 45.5% had coronary heart disease. Fifty-four percent experienced neurologic symptoms (transient in 36%, reversible in 6%, and permanent in 11%). Operations were performed under general anesthesia. An indwelling shunt was inserted whenever routine stump pressure was < 50 mmHg. There were no neurologic complications but one patient died of a compression hematoma of the neck, for a combined mortality and morbidity rate of 1.5%. Arteriograms were obtained from all patients on day 5 and showed complete restoration of normal anatomy in all cases and thrombosis of the external carotid artery in one. During a mean follow-up of 27 +/- 4.7 months no strokes were observed. Follow-up duplex scans showed no hemodynamically significant restenoses. Eversion endarterectomy is a reliable alternative to other reconstruction procedures of the internal carotid artery.

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PubMed2004

Posterior tibial nerve and median nerve somatosensory evoked potential monitoring during carotid endarterectomy.

PURPOSE: Somatosensory evoked potential (SSEP) monitoring using the median nerve (MN) modality during carotid endarterectomy is well established. This study assessed the usefulness of monitoring the posterior tibial nerve (PTN) SSEP as an adjunct to MNSSEP for detection of cerebral ischemia and as an indicator for the insertion of a shunt in patients undergoing a carotid endarterectomy. METHODS: All patients undergoing carotid endarterectomy during three years who had routine bilateral MNSSEP were also monitored with bilateral PTNSSEP. Patients received a shunt if there was a significant change (> 50% decrease in amplitude of cortical peak (N20) in the MNSSEP after cross clamping. The incidence, timing, and duration of all PTNSSEP changes were compared to MNSSEP changes. RESULTS: One hundred fifty-three patients were studied. Significant changes in MNSSEP after cross clamp lead to insertion of a shunt in six patients. Changes in PTNSSEP occurred at almost the same time in three patients, four minutes before MNSSEP in one, three minutes later in one and no change in one patient. Good quality baseline tracings were obtained in 99% MNSSEP as compared to 88% PTNSSEP (P < 0.05). New postoperative neurological deficits occurred in four patients (2.6%), only one had significant evoked potential changes. CONCLUSION: Monitoring of PTNSSEP is feasible and may be considered for an adjunct to MNSSEP or as an alternative modality if there are difficulties with MNSSEP. However, there may be a greater incidence of poor quality baseline tracings for PTNSSEP.

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PubMed2007

Carotid angioplasty and stent placement for restenosis after endarterectomy.

INTRODUCTION: Recurrent carotid stenosis following endarterectomy is a common complication, and reoperation may be associated with increased morbidity. The goal of this study was to determine the procedural safety and long-term complication rates of carotid angioplasty and stenting for recurrent stenosis. METHODS: Of 248 consecutive carotid angioplasty and/or stenting procedures performed at our institution between March 1996 and November 2005, 83 procedures for recurrent stenosis following endarterectomy were performed in 75 patients (mean age 68 years; 43 men, 32 women) without cerebral protection devices. The patients' medical records were retrospectively reviewed for vascular imaging reports and available clinical follow-up. Procedural and long-term complication rates were calculated. RESULTS: Recurrent stenosis was reduced from a mean of 80.6% to no significant stenosis in 82 of 83 procedures. The procedural stroke rate was 3 out of 83 procedures (3.6%). The procedural transient ischemic attack (TIA) rate was 2 out of 83 procedures (2.4%). Mean follow-up was 22.4 months (range 0.1 to 86.7 months) with at least 6 months follow-up for 54 of 83 procedures (65%). There were five TIAs and no strokes on follow-up (new TIAs at 25.5 and 43.4 months; recurrent TIAs at 1, 11.1, and 12 months, all with normal angiograms). The composite 30-day stroke, myocardial infarction, or death rate was 5 of 83 procedures (6.0%). CONCLUSION: In this series, angioplasty and stenting were effective in relieving stenosis secondary to recurrent carotid disease after endarterectomy, and have low rates of ischemic complications.

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PubMed2004

Carotid endarterectomy: experience in 5425 cases.

From 1992 to December 2002, 3967 patients (2619 males; 1348 females) with a mean age of 68.4A years (range 32-92) underwent 5425 carotid endarterectomy (CE) procedures at our institute. Neurological history was positive for stroke in 1130 cases (21%) and for transient ischemic attack (TIA) in 2121 cases (39%). In 2174 cases (40%) patients were neurologically asymptomatic or presented nonspecific symptoms. Our current clinical protocol has been designed to optimize resources and reduce complications. Some of the major features, along with the respective percentages in this series, are as follows. Duplex scanning was performed at a validated laboratory as the principal preoperative exam (86.9%). Locoregional anesthesia and neurological monitoring were performed during carotid cross-clamping (96.3%). Selective shunting was carried out with a Javid shunt (10.7%). The choice of surgical technique was made according to carotid anatomy and cerebral tolerance of cross-clamping. Those used were a standard technique (now abandoned, 12.1%), synthetic patching (46.4%), and eversion endarterectomy (41.5%). Intraoperative completion arteriography was routinely performed for eversion endarterectomy and only in dubious cases with other techniques. The option of staying in an postoperative intensive care unit (ICU) was available (selective use, 2%). In uncomplicated cases, early discharge (after 1.5 postoperative days) was considered safe. The overall perioperative mortality was 0.37% (20/5425). Causes of death were myocardial infarction in seven cases, ischemic stroke in six cases, hemorrhagic stroke in five cases, respiratory failure caused by cervical hematoma in one case, and wound infection in one case. Perioperative neurological morbidity was 1.31% (71/5425); there were 43 major and 28 minor strokes. In conclusion, CE is effective for stroke prevention when there is significant symptomatic and asymptomatic carotid stenosis, as low mortality and morbidity may be achieved in an experienced center. At our institute, the reduction of costs did not have negative consequences on the quality of the surgical care.

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PubMed2005

The incidence of ischemic stroke versus intracerebral hemorrhage after carotid endarterectomy: a review of 2452 cases.

Carotid endarterectomy is a frequently performed vascular procedure. The most common major perioperative neurologic complication is ischemic stroke. Intracerebral hemorrhage has been traditionally viewed as less common. It has been recently proposed that as technical advances are made, the rate of ischemic stroke and other complications has decreased, causing hemorrhagic stroke to attain increasing importance as a perioperative complication. A review of 2452 consecutive endarterectomies performed by a single surgeon from 1983 to 2000 was performed and rates of ischemic and hemorrhagic strokes were analyzed. There were five hemorrhagic strokes for a rate 0.20% (13.5% of postoperative neurologic complications) and 32 with ischemic strokes for a rate of 1.31% (86.5% of postoperative neurologic complications). From these data we conclude that hemorrhagic stroke remains uncommon and ischemic stroke continues to be the most frequent cause of postoperative neurologic complication after carotid endarterectomy.

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PubMed2006

Routine shunting is a safe and reliable method of cerebral protection during carotid endarterectomy.

The purpose of this report is to describe the perioperative and long-term outcomes of standard carotid endarterectomy (CEA) with general anesthesia, routine shunting, and patching and to show that routine shunting is a safe and reliable method of cerebral protection. Between January 1998 and December 2004, 700 patients attending our Department of Vascular Surgery underwent 786 CEAs performed using a standardized technique. Forty-four patients were excluded from the analysis because they underwent combined CEA and coronary artery bypass grafting, so the analysis is based on the results of 742 CEAs in 656 patients (86 bilateral CEAs). The strict surgical protocol included general anesthesia and standard carotid bifurcation endarterectomy with routine shunting (Javid's shunt) and Dacron patching. The Javid shunts were easily inserted in 738 cases (99.4%) but could not be used in four cases (0.5%) because of the presence of a very small internal carotid artery. The mean ischemic time required to insert the shunt and complete the suture was 4.7 min (+/-1.15), and the mean time to perform the endarterectomy was 34.3 min (+/-6.7). The mean follow-up was 24.4 months (+/-17.3). Overall 30-day mortality was 0.1% (one patient) due to a contralateral major stroke. The 1-month perioperative neurological complication rate was 0.7%, with three major and two minor strokes. The cumulative stroke and death rate was 0.8%. Preoperative symptoms such as hypertension, contralateral occlusion, or an age of more than 80 years were not independent risk factors for perioperative stroke. In the long-term follow-up, Kaplan-Meier analysis indicated an estimated 5-year stroke-free rate of 98.0%. There were eight cases (1%) of >70% restenosis (four cases) or thrombosis (four cases) of the operated internal carotid artery during the follow-up in asymptomatic patients: in four cases, carotid stenting due to >70% restenosis led to good results. The Kaplan-Meier estimate of the restenosis-free rate was 97.8%. The combined stroke and mortality rate of 0.8%, and the restenosis rate of 1% support the argument that standard CEA performed with routine shunting as brain protection leads to excellent early and long-term results.

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PubMed1999

Postoperative blood pressure changes associated with cervical block versus general anesthesia following carotid endarterectomy.

The purpose of this report was to determine if cervical block anesthesia (CBA) was associated with fewer hypertensive and hypotensive episodes and decreased need for ICU monitoring following carotid endarterectomy, compared with general anesthesia (GA). A retrospective review of carotid endarterectomies performed using GA (n = 118) versus CBA (n = 116) was carried out and perioperative blood pressure changes and morbidity and mortality rates were analyzed. With increasing emphasis in today's health care market concerning cost containment without sacrificing safety, our results suggest that CBA should be considered preferable to GA for patients undergoing carotid endarterectomy. Fewer significant postoperative hemodynamic changes occurred and costly intensive care monitoring may be avoided.

Aged↗
PubMed1982

Early and late results of combined endarterectomy and coronary bypass grafting for diffuse coronary disease.

Between October 1969 and December 1979, a total of 440 patients who had diffuse coronary artery disease were treated with combined endarterectomy and coronary bypass grafting. This constitutes 42 percent of all patients operated on at the same institution during this period. Six hundred eight endarterectomies were performed, 329 on the right coronary artery, 227 on the left anterior descending coronary artery and 52 on the left circumflex coronary artery. The early mortality rate was 4.3 percent and the late mortality rate 9 percent during a mean follow-up period of 47 months. The perioperative infarction rate was 15 percent. Ninety-five percent of survivors were asymptomatic or in improved condition. Only 11 patients were lost to follow-up study. Three hundred fourteen patients (71 percent) were reinvestigated with coronary and graft arteriography 1 month to 8 years postoperatively. The early patency rate of grafts to the endarterectomized vessels was 85 percent and the late patency rate (1 year or more) was 77 percent. The runoff was good in 79 percent, fair in 14 percent and poor in 7 percent of grafts. Endarterectomy is a valuable additional procedure in the management of patients with diffuse coronary artery disease.

Adult↗
PubMed1990

Early clinical results of long coronary arteriotomy, endarterectomy and reconstruction combined with multiple bypass grafting for severe coronary artery disease.

Within a 2.5-year period between 1985 and 1988, long coronary arteriotomy, endarterectomy and reconstruction (principally left anterior descending artery) and multiple bypass grafting (mean graft rate was 9) were performed in 130 of 329 patients (40%) with severe diffuse coronary artery disease to ensure complete myocardial revascularization. Ninety-two percent of the patients who underwent exercise testing had abnormal (greater than 1 mm ST) depression and/or positive results on scintigraphy. Long coronary arteriotomy (5 to 12 cm), endarterectomy and reconstruction of the left anterior descending artery and its branches, were performed in 121 patients; of the left circumflex artery and its branches in 13 patients; and of the right coronary artery and its branches beyond the crux in 18 patients. Single endarterectomy and reconstruction was performed in 109 patients, double in 20 and triple in 1. The operative mortality was 2.3% and the perioperative infarction was 1.5%. Twenty-four patients (among them 38% who had undergone greater than 1 previous bypass operation) were randomly selected and studied within 20 days after surgery. This group comprised a total of 69 coronary conduits of which 68 (99%) were patent, and a total of 206 coronary anastomoses of which 202 (98%) were patent. Thirty-two of 33 conduits (97%) to endarterectomized and reconstructed arteries were patent. One hundred and twenty-six of 127 patients were followed up for a mean of 20 months; 120 of the 121 patients (99%) were in angina class I by Canadian Cardiovascular Society classification, and 63 of 71 patients (89%) had a normal treadmill exercise stress test.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗