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[Risks and benefits of thrombendarterectomy in bilateral internal carotid artery stenosis]
1Abteilung für Allgemeine, Abdominal und Gefäschirurgie, Universität des Saarlandes, Homburg-Saar.
Insights
Patients with bilateral internal carotid artery stenosis should undergo surgery on the symptomatic side first. This approach improves quality of life and reduces stroke risk compared to conservative treatment.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Context:
- Cerebrovascular insufficiency often involves bilateral internal carotid artery stenosis.
- Surgical intervention versus conservative management for these patients presents distinct risks and outcomes.
Purpose:
- To compare the outcomes of surgical intervention versus conservative treatment for patients with bilateral internal carotid artery stenosis.
- To determine the optimal surgical strategy for patients with bilateral internal carotid artery stenosis.
Summary:
- Retrospective analysis of 47 surgically treated and 28 conservatively treated patients with internal carotid artery stenosis.
- Bilateral stenosis cases had higher morbidity (3.2%) than unilateral cases.
- Operating on the symptomatic side first in bilateral cases reduced permanent neurological deficit.
- Conservative management of bilateral stenosis carried a significantly higher risk of subsequent stroke (14.6%).
Impact:
- Prioritizing surgery on the symptomatic side in bilateral internal carotid artery stenosis improves patient outcomes and quality of life.
- Concomitant coronary artery disease impacts survival but not necessarily quality of life improvements.
- Increased stenosis during observation is a poor prognostic indicator.
- Low-dose aspirin treatment was associated with an increased risk of stroke.
Abstract:
Among the patients who were operated for cerebrovascular insufficiency, one third suffered from bilateral stenoses of the internal carotid artery. In a retrospective analysis of 47 patients who were operated in consecution and of 28 patients who refused operation and were treated conservatively, the outcome was compared to cases with a one-sided stenosis. 31 patients were operated on one side and 16 on both sides. 28 of the surgically treated cases were followed up for an average of 32 months. The morbidity of 3.2% of the bilateral cases was twice as high as that of the unilateral cases. A permanent neurological deficit was observed in 2 patients after reconstruction of the asymptomatic but higher grading stenosis, but in none of the 18 cases after reconstruction of the symptomatic side although the stenosis of the other side was not removed. Patients with bilateral stenoses of the internal carotid artery should therefore be operated first on the symptomatic side. The frequently concomitant coronary artery disease of these patients prevents an improvement of the survival period in the group of bilaterally operated patients. The success in these cases concerns only the quality of life. The risk of a subsequent stroke in the 28 not operated cases with bilateral stenoses was 14.6% and therefore much higher than in the group of operated patients. Increase of the stenoses during the observation period is a prognostically unfavorable sign. Low dose treatment with platelet aggregation inhibitors (less than 500 mg ASS) increased the risk of an apoplectic insult.