Carotid endarteriectomy in patients with contralateral internal carotid artery occlusion - early postoperative results

Abstract

Background. Patients with occlusion of internal carotid artery (ICA) and stenosis of internal carotid artery on the contralateral side are a high risk group for brain stroke. Literature data provide for early operative treatment in this group. Carotid endarteriectomy under local anaesthesia allows for continuous neurological state monitoring and allows a decrease in intraluminal shunt use. The objective of this study was to evaluate the early results of surgical treatment in this group and to evaluate intraluminal shut use rate.
Material and methods. 323 procedures of carotid endarteriectomy were performed in the Department of Cardiac Surgery during the years 2002-2003. The patients were divided into two groups - group I (49 cases) of patients with occlusion of ICA and ≥ 70% stenosis of contralateral ICA, and group II (274 cases) of ≥ 70% ICA stenosis without contralateral occlusion. Group I had significantly more common preoperative neurological incidents and significantly more common ischemic changes in brain CT (p > 0.001).
Results. In group I there were 2 brain infarcts in early observation (4.1%), while in group II 4 neurological incidents were noted (1.5%). No patient died in group I, while 5 patients died in early observation in group II giving mortality of 1.8%. In group I intraluminal shunt was used significantly more commonly (16.3% vs. 2.2%).
Conclusions. The rates of neurological complications were comparable in both groups. Intraluminal shunting was used more commonly in the group with contralateral internal carotid artery occlusion.