The contralateral diseased but asymptomatic carotid artery: to operate or not? An update

Bilaterally diseased carotid arteries were demonstrated in 147 patients in a personal series of 535 carotid reconstructions. A general policy of operating only on symptomatic patients was followed. Although stenotic and ulcerated plaques were known to be present in the contralateral artery, they were not repaired unless new symptoms occurred. No strokes were observed in these patients in a 20 year follow-up period. Twelve percent of the patients became symptomatic, leading to new arteriograms and a second artery repair. The patients at risk and their families were carefully instructed to report any symptoms of cerebrovascular insufficiency. If meticulous follow-up is carried out, the prophylactic repair of a truly asymptomatic diseased carotid artery is not believed necessary to prevent stroke.