Surgical treatment of bilateral carotid artery lesions

Sixty-eight patients (7.1% of all cases) underwent bilateral carotid thrombo-endarterectomy, with one peroperative death due to permanent vascular cerebral ischemia. Two patients were re-operated (saphenous vein) for a thrombosis which had given rise to a totally regressive transient ischemia. The usual surgical technique was not modified for bilateral lesions, and the follow-up was similar. The evolutive risk of bilateral lesions was higher than that for isolated lesions as the risk of an accident after unilateral surgery in bilateral cases remained higher. As regards the surgical technique, we did not observe significant differences between the stump pressures according to the side operated. A one-week interval between the two surgical stages seems necessary and sufficient. Operative indications are studied except in cases of bilateral lesions which are asymptomatic or with former TIA, where surgery is considered mandatory.