The course of atherosclerotic diseases after carotid endarterectomy in 279 patients followed-up for 21 years.

Two hundred and seventy-nine patients underwent 331 consecutive carotid endarterectomies during a 20-year period from 1965 to 1984 and were followed-up for 21 years (median 76.0 months). The procedure-combined mortality was 3.9% (13 out of 331 patients). The mortality was 2-3% during the first 3 years, 4-6% from the fourth to the seventh year, and 9-10% per year thereafter. Late deaths (n = 101) were caused by coronary heart disease (CHD) in 51% by cerebrovascular disease (CVD) in 17% and by other causes in 32% of the cases. The ratio of CHD to CVD deaths, 3:1, is similar to a normal population. The possibility of dying in a cerebrovascular accident is six-fold in untreated patients when compared to the results in this study. The combined incidence of fatal and non-fatal strokes during the first and fifth year was 3%, and otherwise 1-2%. The other manifestations of atherosclerosis, CHD, and peripheral arterial occlusive disease were combined with CVD in 68.5% of the cases. The frequency of CHD was significantly combined with elevated serum triglyceride, and apolipoprotein B concentrations, decreased serum high density lipoprotein cholesterol concentrations at the control examination, and frequency of hypertension. Therefore, it would be important to follow such patients and reduce the risk factors of CHD.