[Surgery of the carotid: the morphology of plaque and the clinical correlations].

A consecutive series of 256 patients operated on of carotid endarterectomy for cerebrovascular atherosclerotic disease from January 1987 through December 1990 is presented. The following parameters were considered: clinical presentation, morphology of the carotid atherosclerotic plaque and topographic distribution of other concomitant atherosclerotic lesions of epiaortic arteries. 422 carotid lesions and 154 lesions of other epiaortic vessels were investigated by means of echo and color flow imaging, digital subtraction angiography and macroscopic observation of the specimen: 143 plaques proved grossly ulcerated. Unilateral lesions were 90 (35.2%) while bilateral disease was present in 166 cases (64.8%): 38.8% of subjects out of the first group and 30.2% out of the second were asymptomatic. Anterior and posterior neurological symptoms were equally distributed among both the 116 (69.8%) symptomatic subjects harboring bilateral lesions and the 55 (61.1%) symptomatic subjects with unilateral lesion (anterior 78.4% and posterior 21.6% for bilateral and 78.2% and 21.8% respectively for unilateral lesions). According to the degree of stenosis, the lesions were divided into three main groups: < 50%; 50-70%; > 70%. As the degree of stenosis increased, the incidence of focal symptoms increased too; moreover, the presence of ulceration of the stenosing plaque carried an increase in the incidence of focal symptoms within each group: respectively from 7.8% to 30% (< 50%), from 18.6% to 53.8% (50-70%), from 27.7% to 55.6% (> 70%). This study supports the relationship of morphological characteristics of the stenosing atherosclerotic plaques of the internal carotid artery to neurological symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)