Carotid endarterectomy in patients with contralateral internal carotid artery occlusion

Abstract

Introduction. Carotid artery occlusion is the cause of death or disabling cerebral symptoms in 1/3 of patients. The aim of the study was to analyse the perioperative results of carotid endarterectomy (CEA) depending on the patency of the contralateral internal carotid artery (ICA).
Material and methods. Four hundred and twenty-two CEA were performed in 390 patients between 1990–1998. Sixty-five (16.7%) patients had contralateral ICA occlusion (group I). The rest, 325 patients (83.3%), had patent contralateral ICA - group II. We operated on mainly severe (> 70%) ICA stenoses (94.8%). The preoperative risk factors were similar in both groups. Preoperative severe stroke on the operated ICA side was significantly more often observed in group I (p = 0.01). Standard CEA with direct arterial suture was performed in all cases.
Results. Preoperative computed tomography (CT) scan revealed more often ischaemic focus on the operated side in group I (p < 0.001). Intraoperative shunt was significantly more often used in patients with contralateral ICA occlusion (p < 0.001). The perioperative stroke from the operated side was observed in 3% patients from group I and in 3.1% from group II. Contralateral stroke occurred in 1.5% from group I, and 0.56% from group II. Mortality rate was respectively 1.5% for group I, and 1.3% for group II (p = NS).
Conclusions. Risk of preoperative stroke and mortality rate were not higher for patients with contralateral ICA occlusion. Intraoperative shunt was significantly more often used in patients with contralateral ICA occlusion.