Pre- and postoperative MRI Evaluation of Silent Neurological Lesions in Asymptomatic Carotid Surgery

did not take account of the type of cerebrovascular accident (CVA) observed. However the junctional strokes (JS) rather of hemodynamic origin and the territorial strokes (TS) rather of embolic origin, have different evolutionary prognosis and risk of recurrence. Is neurological risk of carotid surgery higher after a JS? The aim of this study was to compare the rate of postoperative neurological aggravation in the 30 days after carotid endarterectomyfor a symptomatic stenosis, according to whether the CVA was junctional or territorial. Materials and Methods: We present a tri-centric retrospective continuous and consecutive study of 222 patients, operated between 2009 and 2013 of a carotid endarterectomyfor a stenosis >50% responsible for an ipsilateral carotid CVA, junctional or territorial. Patients with a mixed CVA were excluded. The age, the gender, the cardiovascular risk factors, the preoperative NIHSS score, the time between the occurrence of neurological symptoms and operation, the degree of stenosis of the operated carotid and the contralateral carotid, the need for a shunt, the duration of peroperative clamping as well as the procedure were analyzed. The criterion of judgment was the rates of death and neurological events (strokes and TIA) during the 30 postoperative days. The data were studied by the Chi-2 test for the qualitative variables and by a test resulting from a Student test for the quantitative variables. Results: The demographic and clinical characteristics of the patients of the two groups did not present a significant difference. The cumulated rate of morbi-mortality was significantly higher after a JS (p 1⁄4 0.0076). Conclusion: This study pleadsfor a more precise analysis of the type of CVA which must be taken into account in the operative indication for symptomatic carotid stenoses. A study conducted on a larger scale is necessary to stratify the operative riskand to optimize the surgical management, in accordance with the initial type of CVA.