Surgical management of the patient with bilateral internal carotid artery occlusion

Area of Science:

• Vascular Surgery
• Cerebrovascular Disease
• Neurology

Background:

• Bilateral internal carotid artery occlusion presents a significant stroke risk.
• Current treatments like medical management and extracranial-intracranial bypass show limited efficacy.
• Cerebrovascular insufficiency symptoms are common in these high-risk patients.

Purpose of the Study:

• To evaluate the effectiveness of external carotid artery revascularization in patients with bilateral internal carotid artery occlusion.
• To assess the safety and durability of this surgical intervention.
• To determine if external carotid artery revascularization can prevent stroke and improve patient outcomes.

Main Methods:

• Retrospective analysis of 12 patients with bilateral internal carotid artery occlusion.
• Nineteen procedures of external carotid artery revascularization were performed.
• Evaluation of perioperative outcomes and long-term follow-up for stroke incidence and symptoms.

Main Results:

• No perioperative strokes or deaths were recorded in any of the patients.
• During a mean follow-up of 44.7 months, no new strokes occurred.
• Among 10 patients treated with external carotid artery revascularization alone, only one transient ischemic attack was observed.

Conclusions:

• External carotid artery revascularization appears to be a safe and effective treatment for patients with bilateral internal carotid artery occlusion.
• The procedure demonstrates durability in preventing stroke and improving symptoms of cerebrovascular insufficiency.
• Seven of eight surviving patients are asymptomatic, suggesting significant long-term benefit.