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Thirty two carotid artery operations for atherosclerotic occlusive lesions have been performed on 28 patients with an operative mortality of 6 per cent. Immediate symptomatic improvement occurred in 1 of 12 patients operated for a complete occlusion while 10 of 15 patients surviving surgery for a partial occlusion were improved immediately. Seven patients died during the follow up period; 6 from unrelated causes and 1 from progressive cerebral vascular insufficiency. One patient was lost to long-term follow-up. Eighteen patients are surviving from 40 to 78 months following surgery. Nine patients classified as improved in the early postoperative period have maintained their improvement. Six of these patients have had postoperative arteriographic studies, and in all instances the operated vessel was patent. Two of the 9 patients developed symptoms of insufficiency of the opposite carotid artery 3½ and 4 years after surgery. Arteriographic studies demonstrated patency of the operated vessel and significant narrowing of the contralateral vessel. The patients are symptom-free following a second carotid artery operation. Four patients operated for complete occlusion of an internal carotid artery who were classified as unimproved in the early postoperative period have improved significantly during the late follow-up period. Five of the 18 long-term patients have neither improved nor demonstrated any progression of symptoms of cerebral vascular insufficiency. [ABSTRACT FROM AUTHOR]