Surgical therapy for recent total occlusion of the internal carotid artery

From January 1980 until May 1983, 24 patients had surgical exploration of the carotid bifurcation for suspected recent total occlusion of the internal carotid artery (ICA). All patients had recent onset of neurologic symptoms related to the ipsilateral cerebral hemisphere. Selective carotid angiography determined preoperative total occlusion of the ICA. Because surgery failed to reopen the ICA in nine patients, they had endarterectomy of the external carotid artery. Fifteen patients had initially successful thromboendarterectomy of the ICA. Prior to patient dismissal, patency was documented by B-mode ultrasound or digital subtraction angiography (DSA). All 15 patients had another B-mode ultrasound scan or DSA at least 45 days after thromboendarterectomy. On reexamination four ICAs were reoccluded, but only one patient became symptomatic. There were no operative deaths and no increase in preoperative neurologic deficits. The natural history of patients with total occlusion of the ICA is variable. The most important factor influencing a therapeutic decision is the patient's neurologic status. This study supports an aggressive, early surgical intervention for recent total occlusion in carefully selected patients.