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[Indications for surgery of carotid artery stenosis with contralateral carotid occlusion]
Insights
This study on carotid artery stenosis with contralateral occlusion found high early mortality, particularly in patients with advanced neurological deficits. However, recent surgical techniques significantly reduced mortality rates.
Area of Science:
- Vascular Surgery
- Neurology
- Clinical Outcomes
Context:
- Retrospective analysis of 69 patients with carotid artery stenosis and contralateral carotid occlusion.
- 10% of patients with carotid artery stenosis presented with contralateral occlusion.
- Patients often had advanced neurological deficits (Stage IV) on the side of occlusion.
Purpose:
- To report the course and outcomes of patients undergoing surgery for carotid artery stenosis with contralateral carotid occlusion.
- To evaluate early and late mortality and morbidity rates.
- To assess the impact of surgical period on outcomes.
Summary:
- Early lethality was 10%, with a 21% late mortality rate over a mean follow-up of 3.0 years.
- Patients with preoperative neurological Stage IV on the stenosis side had the highest mortality.
- Surgical revascularization was not possible in 5 out of 7 patients operated on for the occlusion.
- Venous patch closure (88%) and intraluminal shunts (97%) were commonly used.
- A significant reduction in early mortality was observed in the later surgical period (1979-1981) with a 3% mortality rate.
Impact:
- Highlights the risks associated with carotid artery stenosis and contralateral occlusion.
- Demonstrates the improvement in surgical outcomes with evolving techniques and experience.
- Suggests a need for careful patient selection and optimized surgical strategies for this complex condition.
Abstract:
In a retrospective study the course of 69 patients of the Surgery Department of the University of Heidelberg (66 men, 3 women, mean age 60 years) with carotid artery stenosis with contralateral carotid occlusion has been reported. 10% of the patients with carotid artery stenosis had a contralateral occlusion. Corresponding to the side of occlusion most patients had a preoperative neurological stage IV (55%, 19% stage II, 26% stage I) and corresponding to the side of stenosis most patients had a stage I (57%, 28% stage II, 4% stage III, 12% stage IV). In addition to the stenosis the occlusion had been operated on in 7 patients, in 5 of them the revascularisation was not possible. In 88% the arteriotomy could be closed using a venous patch and in 97% a intraluminal shunt was used. All operations were done under general anesthesia. The early lethality rate was 10%, in one patient a postoperative neurological deficit occurred. The late mortality rate was 21%, in 5% a new neurological deficit could be found (n = 57, mean follow-up: 3.0 years). In relation to the preoperative neurological stage corresponding to the side of stenosis the highest mortality rate was found in patients with stage IV. In a separate analysis of two periods (1962-1978 and 1979-1981) it can be demonstrated that the high early mortality rate is nearly entirely found in the first period with a low operative frequency. In the second period 1979-1981, 33 carotid endarterectomies in patients with contralateral occlusion were operated with a mortality rate of 3%.(ABSTRACT TRUNCATED AT 250 WORDS)