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Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
07:46

Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia

Published on: May 9, 2013

Does contralateral internal carotid artery occlusion increase the risk of carotid endarterectomy?

B A Perler1, J F Burdick, G M Williams

  • 1Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21205.

Journal of Vascular Surgery
|September 1, 1992
PubMed

Insights

Carotid endarterectomy outcomes were similar when performed contralateral to an internal carotid artery occlusion versus a patent artery. This study found comparable perioperative stroke and mortality rates between the two groups.

Area of Science:

  • Vascular Surgery
  • Cerebrovascular Disease
  • Cardiovascular Outcomes

Background:

  • Carotid endarterectomy (CEA) is a common procedure to prevent stroke.
  • The impact of contralateral internal carotid artery (ICA) status on CEA outcomes is debated.
  • Understanding risks associated with CEA in the setting of contralateral ICA occlusion is crucial for patient selection and management.

Purpose of the Study:

  • To compare the outcomes of CEA in patients with contralateral ICA occlusion versus those with a patent contralateral ICA.
  • To assess perioperative stroke, mortality, and cardiac complication rates in these two patient groups.

Main Methods:

  • Retrospective comparison of 36 patients undergoing CEA contralateral to ICA occlusion (Group I) and 169 patients with patent contralateral ICA (Group II).
  • Patients were matched for age, gender, hypertension, diabetes, and hyperlipidemia.
  • Outcomes analyzed included perioperative stroke, operative mortality, and cardiac complications.

Main Results:

  • No significant difference in perioperative stroke rates (2.8% vs 4.1%) or operative mortality (0% vs 1.2%) between Group I and Group II.
  • Group I patients had a higher incidence of prior myocardial infarction and exertional angina.
  • Perioperative stroke incidence in Group II did not correlate with the degree of contralateral ICA stenosis.

Conclusions:

  • CEA can be performed with similar safety and efficacy regardless of contralateral ICA status (occluded or patent).
  • Patients with contralateral ICA occlusion may have higher pre-existing cardiac comorbidities.
  • The degree of contralateral ICA stenosis does not appear to significantly influence perioperative stroke risk in patients undergoing CEA.

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