Carotid endarterectomy in patients with contralateral carotid occlusion: is the risk increased?

Many vascular surgeons believe the risk of carotid endarterectomy is greater if the patient has a contralateral carotid occlusion, and thus believe intraoperative shunting is mandatory. Five hundred and eleven carotid endarterectomies were performed over the last 11 years by two of us (JEM and RAL). Of these, 370 had charts available for detailed analysis. Twenty-seven of these patients had complete occlusion of the contralateral carotid artery. Eight of these 27 patients were asymptomatic and 16 patients had transient ischemic attacks prior to surgery. Two patients had strokes which were stable at the time of surgery. One patient with a previous stroke was operated upon emergently with a new stroke in evolution. All were operated upon under general anesthesia and only three had intraoperative shunting. Occlusion time averaged 17.1 minutes varying from 11 to 34 minutes. There were two deaths, one cardiac and one pulmonary, and no postoperative strokes either temporary or permanent. Of the 343 patients without contralateral occlusion, three patients (.87%) died, and there were 19 (5.5%) neurologic complications of which seven (2%) were present at the time of hospital discharge. It appears that contralateral carotid occlusion does not increase the risk of stroke after carotid endarterectomy even when intraoperative shunting is not used.