Forty-five consecutive patients with unstable carotid artery syndrome were evaluated and treated, 23 surgically and 22 medically. Early cerebral angiogra phy and carotid endarterectomy yielded permanent neurologic morbidity/mor tality incidences of 0% and 8.7%, respectively. Despite a fairly high incidence of stroke acutely and during the follow-up period (24% and 8%, respectively), 80% of the total group continued at their baseline, prepresentation level of daily function at an average follow-up of 22.3 months. Aggressive clinical manage ment of this patient group is generally safe, but the efficacy of such manage ment remains unproven.
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