Bilateral occlusive carotid disease: simultaneous or staged operation?

Area of Science:

• Vascular Surgery
• Cerebrovascular Disease Management
• Surgical Outcomes Research

Background:

• Carotid artery disease poses a significant risk of stroke.
• Surgical interventions aim to restore blood flow and prevent ischemic events.
• Bilateral carotid artery disease presents unique surgical challenges and treatment considerations.

Purpose of the Study:

• To compare the outcomes of staged versus simultaneous bilateral carotid artery surgery.
• To evaluate the safety and efficacy of combined external carotid desobliteration with extra-intracranial arterial bypass.
• To identify specific benefits and potential risks associated with simultaneous bilateral carotid reconstruction.

Main Methods:

• Retrospective analysis of 231 carotid operations in 202 patients.
• Categorization into staged bilateral (Group A), simultaneous bilateral (Group B), and combined procedures (Group C).
• Documentation and comparison of patient recovery, complications, and mortality rates.

Main Results:

• Groups A and C experienced uneventful recoveries, with one late mortality in Group A due to contralateral cerebral infarction.
• Group B (simultaneous bilateral) had one mortality from myocardial reinfarction and four other complications (hematoma, nerve palsy, brainstem deficit, respiratory failure).
• Simultaneous bilateral carotid reconstruction demonstrated benefits including elimination of a risky interval, avoidance of a second anesthesia, and shorter hospitalization.

Conclusions:

• Simultaneous bilateral carotid reconstruction offers significant advantages in selected patients.
• Careful patient selection is paramount to mitigate risks associated with simultaneous procedures.
• The findings support the recommendation of simultaneous bilateral carotid reconstruction in appropriate cases.