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Carotid endarterectomy in patients with contralateral carotid occlusion
Insights
Carotid endarterectomy is safe for patients with carotid stenosis and contralateral occlusion, showing excellent results and low morbidity. Annual screening is recommended for asymptomatic cases to consider prophylactic surgery.
Area of Science:
- Vascular Surgery
- Neurology
- Cerebrovascular Disease
Background:
- Contralateral carotid occlusion presents unique challenges for carotid endarterectomy.
- Assessing the safety and efficacy of carotid endarterectomy in this specific patient group is crucial.
Purpose of the Study:
- To evaluate the outcomes of carotid endarterectomy in patients with carotid stenosis and a blocked contralateral carotid artery.
- To determine the risks and benefits of this procedure in a high-risk population.
Main Methods:
- Retrospective analysis of 357 patients undergoing carotid endarterectomy.
- Monitoring of intraoperative electroencephalographic (EEG) findings and cerebral blood flow (CBF).
- Assessment of major and minor neurologic morbidity, perioperative mortality, and overall outcomes.
Main Results:
- Overall major neurologic morbidity was 0.6%, with minor morbidity at 1.1%.
- An excellent outcome was achieved in 97.2% of patients.
- 46% of patients required shunting due to significant intraoperative EEG and CBF changes, indicating limited collateral flow.
Conclusions:
- Carotid endarterectomy can be performed with low risk in patients with contralateral carotid occlusion.
- Annual noninvasive carotid testing is advised for asymptomatic patients with this condition.
- Prophylactic endarterectomy may be considered if stenosis progresses, given the higher risk of stroke.
Abstract:
In this study, we assessed the results of carotid endarterectomy in 357 patients with a carotid stenosis and contralateral carotid occlusion. The overall major neurologic morbidity was 0.6%, and the minor morbidity was 1.1%. The causes of four perioperative deaths (1.1%) were myocardial infarction in two patients, ruptured abdominal aortic aneurysm in one, and respiratory complications in one. Therefore, an excellent result was achieved in 97.2% of patients. With occlusion of the carotid artery for the endarterectomy, 165 patients (46%) had appreciable attenuation in intraoperative electroencephalographic findings and a decrease in cerebral blood flow to approximately 10 ml/100 g of brain tissue per min that necessitated placement of a shunt. This high percentage of profound electroencephalographic and blood flow changes during carotid occlusion suggests that the potential for collateral blood flow in this group of patients is minimal. These results demonstrate that a carotid endarterectomy can be performed at low risk in patients with a contralateral carotid occlusion. We advocate annual noninvasive carotid testing for patients with asymptomatic carotid stenosis and contralateral carotid occlusion. If progression of the stenosis is evident, a prophylactic endarterectomy should be considered because these patients may have a higher risk for cerebral infarction than do patients with a unilateral asymptomatic stenosis.