Treatment of the totally occluded carotid artery

Thirty-four patients, each with a totally occluded common or internal carotid artery, were treated over a 15-year period. Seventeen patients were treated nonsurgically, 17 underwent surgery. There were four patients in the nonsurgical group and six patients in the surgical group who were followed up until death. The average time span from diagnosis of carotid occlusion until death was 4.75 years in the nonsurgical group and 4.52 years in the surgical group. In the nonsurgical group, recurrent symptoms of cerebrovascular accident (CVA) developed in 60% of the patients available for extended follow-up. In contrast, 14% of the patients operated on and available for follow-up had recurrent symptoms, and no CVAs occurred postoperatively. From our data, we concluded that the stroke-free interval is improved, whereas survival is unaffected in the surgically treated patient. Endarterectomy of a contralateral stenotic carotid artery is particularly successful in achieving this reduction in morbidity.