Management of internal carotid artery occlusion

Although attempts to restore patency of occluded internal carotid arteries are now rarely made, endarterectomy in the contralateral artery, external carotid endarterectomy and until recently EC/IC bypass have remained surgical options in the management of such patients. Over a four-year period at this institution 104 patients underwent carotid endarterectomy for stenosis. In this group the contralateral carotid was patent (Group A). Fifty-four patients with unilateral carotid artery occlusion underwent contralateral endarterectomy (Group B), 8 underwent ECA/ICA bypass (Group C) and 4 an ECA endarterectomy (Group D). No statistically significant difference was noted in perioperative stroke and death rates for Groups A and B were (1% and 1%) and (3.7% and 1.9%) respectively. One Group C patient died from perioperative stroke (12.5%). For late events the life table adjusted annual rates for stroke and mortality were similar, Group A (stroke 2.1% and death 5%), and Group B (stroke 1.6% and death 5%). In Group C stroke rate was 10% and death 3%. All four patients undergoing ECA endarterectomy were relieved of their symptoms. It is concluded that in patients with internal carotid artery occlusion TEA may be performed with perioperative morbidity and mortality rates comparable to those when the opposite carotid artery is patent. The late outcome for stroke compares favorably with the reported natural history of the disease and outcome for such patients treated medically in the Joint Study of Extracranial Occlusion and EC-IC Bypass Study. External carotid artery endarterectomy appears useful in the treatment of embolic events on the occluded side. ECA/ICA bypass does not appear to confer benefit.