Background: The surgical treatment of internal carotid artery (ICA) stenosis in patients with contralateral ICA occlusion is associated with significant mortality and morbidity. This may be reduced by improving the hemodynamic reserve of the central nervous system i.e. by performing external carotid artery (ECA) endarterectomy of the artery ipsilateral to the occluded ICA.
The aim of the study was a retrospective result analysis of external carotid artery (ECA) endarterectomy in patients with ipsilateral ICA occlusion.
Material and methods: During the last 4 years (2000–2003) 458 carotid artery endarterectomies including 32 external and common carotid artery (CCA) endarterectomies were performed in the Department of Vascular Surgery and Angiology of the Medical Centre of Postgraduate Studies. The patients were assessed by analyzing their neurological status, perioperative complications and most of all - by monitoring the changes in the medial cerebral artery (MCA) flow.
Results: Among some of the patients, significant cerebral blood flow changes (as seen in the MCA) were noted: the average blood flow decrease during the vessel clamping was on average reduced by 23.35%, and significantly increased after the release of the clamps (on average by 18.8%). The authors registered a microebolism during all periods of the operation among the significant number of patients. In 2 cases - the ICA was revascularised successfully.
Conclusions: The ECA endarterectomy may improve the cerebral blood flow in a substantial number of patients with ICA occlusion and ipsilateral ECA stenosis. This may lower the perioperative risk, when a contralateral ICA endarterectomy is needed. The external carotid endarterectomy seems to be a safe procedure, with a minimal risk of perioperative complications.