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[High-degree bilateral carotid stenoses]
S Fraunhofer1, D Kiossis, H Helmberger
1Abteilung für Gefässchirurgie, Klinikum rechts der Isar der Technischen Universität München.
Insights
Carotid endarterectomy is effective for preventing stroke, even with bilateral carotid disease. However, operating on both sides increases surgical risks like morbidity and mortality compared to unilateral procedures.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
Background:
- The optimal management strategy for patients with bilateral carotid artery stenosis remains a subject of clinical debate.
- Uncertainty exists regarding the appropriate indications for carotid endarterectomy in unilateral versus bilateral disease and the associated operative risks.
Purpose of the Study:
- To evaluate the outcomes and risks of carotid endarterectomy in patients with bilateral carotid artery disease.
- To compare the surgical results and complication rates between unilateral and bilateral carotid endarterectomies.
Main Methods:
- Retrospective analysis of 578 carotid endarterectomies performed between 1986 and 1992.
- Inclusion of 54 patients (9.3%) diagnosed with bilateral carotid artery disease.
- Categorization of patients based on symptom presentation (asymptomatic, unilateral symptoms, bilateral symptoms).
Main Results:
- Surgical success in restoring blood supply (75%) and recurrent stenosis rates (8%) were similar for unilateral and bilateral carotid endarterectomy.
- Patients undergoing bilateral carotid endarterectomy experienced significantly higher operative morbidity (2.8%) and mortality (1.8%) compared to the overall study population (1.9% and 0.45%, respectively).
- 30% of patients with bilateral disease were asymptomatic, and 16% presented with symptoms from both sides.
Conclusions:
- Carotid endarterectomy demonstrates effectiveness in stroke prevention, particularly in patients with multi-vessel cerebrovascular disease.
- While surgical outcomes are comparable, bilateral carotid endarterectomy is associated with increased operative risks (morbidity and mortality).
- Careful consideration of risks versus benefits is warranted for patients requiring bilateral carotid endarterectomy.
Abstract:
The indication for carotid endarterectomy in patients with unilateral stenotic lesions as well as the operative risk in patients with bilateral disease is still controversial among experts. We performed a retrospective analysis in our patients with bilateral carotid endarterectomy. 578 patients underwent carotid endarterectomy at our institution from 1986-1992: 54 patients (9.3%) had bilateral carotid disease. 30% of these patients were asymptomatic and 16% had symptoms from both sides. Surgical results concerning the optimal restoration of blood supply (75%) and the occurrence of recurrent stenosis (8%) were comparable for patients with unilateral and bilateral carotid endarterectomy. On the contrary, in patients with bilateral carotid disease, both the operative morbidity (2.8%) and mortality (1.8%) were increased as compared to the total study population (1.9% and 0.45% resp.). Carotid endarterectomy is very effective in preventing stroke especially in patients with multiple vessel disease as compared to the natural history of these lesions.