Surgical management of the totally occluded carotid artery

Surgical revascularization of the completely occluded carotid artery was evaluated in 19 symptomatic patients who had recurrent episodes of amaurosis fugax or transient hemiparesis. Nine had complete internal carotid occlusion on arteriography and 10 had severe stenosis which had progressed to total occlusion by the time of surgical exploration. At operation irreparable fibrotic changes were observed in four patients, but in 15 a pattern of proximal focal obstruction with relatively healthy distal internal carotid vessels was observed. Thromboendarterectomy produced good back-bleeding in most of these and resulted in improved carotid flow after operation. Seventeen of 19 patients were relieved of symptoms. Two patients continued to have symptoms, but less frequently. There were no deaths after operation. Follow-up from 3 to 36 months showed no change from immediate postoperative results. This study suggests that carotid artery exploration and thromboendarterectomy should be considered when transient ischemic episodes are present despite complete internal carotid artery occlusion.