Risk of early controlateral carotid endarterectomy

Between January 1984 and January 1994, we performed early endarterectomy of the controlateral carotid on 94 patients within a delay of 1 to 8 days after the first endarterectomy. Lesions were symptomatic in 58 patients (62%) and asymptomatic in 36 patients (38%). Eighty-four operations were performed under cervical block anesthesia (89%), eight under general anesthesia, and two under local anesthesia (2%). Severe intraoperative hypertension occurred in seven patients (7%) including five under cervical block anesthesia (6%) and two under general anesthesia (25%). Two patients (2.1%) died of stroke secondary to carotid thrombosis in one case and hyperperfusion syndrome in one case. Morbidity included one transient ischemic attack (1%) and one myocardial infarction (1%). Postoperative control of patency revealed asymptomatic occlusion of the internal carotid artery in two patients, accounting for one of the two deaths. Our findings demonstrate that neurologic mortality/morbidity is not higher after early controlateral carotid endarterectomy than unilateral endarterectomy.