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Prospective study of carotid endarterectomy and contralateral carotid occlusion
A F da Silva1, P McCollum, T Szymanska
1Audit Committee of the Vascular Surgical Society of Great Britain, UK.
Insights
Carotid endarterectomy (CEA) with contralateral internal carotid artery occlusion shows a slight, non-significant increase in stroke and death rates. These outcomes are lower than previously reported, suggesting CEA is safe for these patients.
Area of Science:
- Vascular Surgery
- Neurology
- Clinical Outcomes Research
Background:
- Carotid endarterectomy (CEA) is a procedure to prevent stroke.
- Contralateral internal carotid artery occlusion is a common finding in patients undergoing CEA.
- Previous studies reported a high stroke rate (around 10%) for CEA in patients with contralateral occlusion.
Purpose of the Study:
- To compare complications and outcomes of CEA in patients with and without contralateral internal carotid artery occlusion.
- To assess the safety and efficacy of CEA in the presence of contralateral carotid occlusion.
Main Methods:
- Prospective study of 700 patients undergoing CEA in the UK and Ireland.
- Comparison of outcomes between patients with (n=108) and without contralateral internal carotid artery occlusion.
- Data collection on perioperative complications, including stroke and death.
Main Results:
- Patients with contralateral occlusion had a higher incidence of arrhythmia and stroke.
- Significantly more intraoperative shunts were used in the occlusion group (83.3% vs 64.7%).
- The combined death and stroke rate was 5.6% for the occlusion group versus 2.4% for the non-occlusion group (P not significant).
Conclusions:
- CEA in patients with contralateral carotid artery occlusion carries only a slight increase in postoperative stroke and death.
- This increase was not statistically significant and is lower than previously reported.
- CEA appears to be a safe procedure for patients with contralateral internal carotid artery occlusion.
Abstract:
A total of 700 patients who had carotid endarterectomy (CEA) in the UK and Ireland during a 6-month interval between March and August 1994 were studied prospectively. Some 108 patients (15.4 per cent) had a contralateral internal carotid artery occlusion. Previous reports have shown an associated stroke rate of about 10 per cent in these patients. This study assessed complications and outcome for patients undergoing CEA with contralateral internal carotid artery occlusion compared with those without. The indications for surgery were comparable between the two groups although the patients with occlusion had a slightly higher incidence of arrhythmia and stroke. Intraoperative shunts were used in a significantly higher proportion of those with occlusion (83.3 versus 64.7 per cent, P = 0.0001). The combined death and stroke rate for patients with occlusion was 5.6 per cent compared with 2.4 per cent for the remainder (P not significant). On the basis of the present data, CEA with a contralateral carotid artery occlusion carries only a slight increase in the rate of postoperative stroke and death. This increase was not statistically significant and is lower than that reported previously.