In this study the operative and postoperative results in 84 patients older than seventy-five years who underwent 106 surgical interventions of the carotid system are compared with those of 320 patients aged less than seventy-five who underwent 413 similar procedures.The authors encountered 2 (2.4%) permanent and 1 (1.2%) transient central nervous system ischemic events in patients older than seventy-five, whereas in younger patients there were 4 (1.3%) permanent and 5 (1.6%) transient events. In addition there were 2 deaths (2.4%) in the older group and 5 (1.6%) in the younger group. These differences are not statistically significant and suggest that age alone should not be a contraindication to surgical interventions of the carotid system.

The authors report 9 cases of carotid artery aneurysms in 7 patients from a total of 564 carotid artery operative procedures (1.6%) performed at the Vascular and Thoracic Surgical Clinic of the "Heidehaus" Municipal Hospital of Hannover and the Surgical Department of the West Attica Hospital of Athens Greece. In 4 cases excision of the aneurysm followed by polytetrafluoroethylene 6-mm graft interposition was performed; 1 patient was treated with end-to-end anastomosis, 1 with ligation of the internal carotid artery (ICA), and 3 with excision followed by interposition of vein graft. Histologic examination showed 7 aneurysms to be atherosclerotic, and a female patient had bilateral microcystic degeneration of the middle layer of the ICA. 519From the

Injury of the cranial nerves during surgery of the carotid system is a rela tively common problem. The damage often escapes the attention of the surgeon, and its severity and consequences for the patient are not usually properly evalu ated. In this study the authors examined the immediate postoperative status of the cranial nerves in 404 patients who underwent 519 operative procedures for a variety of conditions affecting the carotid artery system. The authors identified 13 instances of injury (2.5%) 4 of which were perma nent (0.8%) and 9 transient (1.7%). The hypoglossal nerve was permanently injured in 2 instances (0.4%) and the recurrent laryngeal nerve in another 2 (0.4%). In 6 instances (1.2%) the injury to the hypoglossal was transient, as it was in 3 instances of recurrent laryngeal nerve injury (0.6%).

The authors present the results of surgical correction of kinking and coiling of internal carotid in 63 patients who underwent 68 procedures; 51 patients (53 procedures) had kinking of the artery and 12 (15 procedures) had coiling. There were 2 intraoperative or postoperative deaths (2.9%) and 1 permanent cerebral ischemic event (1.5%). In 3 cases (4.4%) there was paresis of the ipsilateral recurrent laryngeal nerve with complete remission within six weeks. These results indicate that surgical correction is the treatment of choice for these anatomic lesions.