[Carotid lesion associated with contralateral occlusion: diagnostic and therapeutic approach]

The treatment of atheromatous carotid lesions combined with occlusion of the contralateral carotid artery remains a problem and one that is much debated. With this in mind the present paper reports personal experience of 25 cases, 16 treated surgically and 9 medically. The criteria for the selection of either type of treatment on the basis of the clinical situations, angiographic findings and Doppler ultrasound studies of the carotid plaque, are analysed. The surgical technique and the methods used in monitoring and protecting the brain during the operation are reported as are the short and long-term results. Finally, it is claimed that an "aggressive" approach is appropriate in such cases, thought there are situations in which careful monitoring of the lesion may be the first logical reaction to the treatment of these patients.