Carotid endarterectomy in cerebral vascular disease.

Clinical and pathological classification and the scope of surgery The clinician divides cerebrovascular disease into three categories, the stage of transient ischaemic attacks, the stage of progressing stroke and the stage of completed stroke. The division is sometimes hard to apply and transient attacks may occur after a completed stroke. Only the first and third stages will be considered here. In general these clinical stages may be associated with disease of small blood vessels or of large vessels either inside the skull or in the neck. Sometimes more than one type of vessel is involved. Moreover, extracranial disease, especially at the carotid bifurcation, is quite common, occurring in many people without brain disease, and it may not necessarily be the cause of symptoms in those who have them. Furthermore, whereas a carotid stenosis is operable, carotid occlusion which has been present for more than 1 or 2 days may not be correctable and the cir-