Surgery of carotid stenoses associated with contralateral obstruction

Surgical correction of stenosing lesions of the extracranial cerebral arteries, responsible for reduced encephalic perfusion, may prevent neurological damage, even when there is bilateral involvement of carotid arteries (stenosis + obstruction). Moreover in these patients poor haemodynamical conditions are thought to be responsible for high perioperatory neurological morbidity and mortality. From case histories with no mortality and low neurological morbidity, other authors state that revascularization of a stenotic carotid artery may be carried out with a reasonable safety margin, even when there is an obstructive lesion of the contralateral carotid artery. On the basis of the 64 cases of revascularization carried out in patients with obstructions of an internal carotid artery associated with a stenotic lesion of the contralateral, we have made a survey of the results, indications and possibilities of treatment in these patients.