Simultaneous bilateral carotid endarterectomies

Area of Science:

• Vascular Surgery
• Neurology
• Anesthesiology

Background:

• Internal carotid artery disease poses a significant risk for stroke.
• Bilateral disease requires careful management strategies.
• Previous approaches often involved staged surgeries, increasing patient risk.

Purpose of the Study:

• To evaluate the safety and feasibility of performing bilateral carotid endarterectomy in a single operative session.
• To determine if a single-stage bilateral procedure is a viable alternative to staged operations.

Main Methods:

• Twelve patients with symptomatic bilateral internal carotid artery lesions underwent simultaneous bilateral carotid endarterectomy.
• Patients were selected based on neurological clearance and comprehensive angiography.
• General anesthesia was employed, with stump pressure measurements guiding collateral flow adequacy.

Main Results:

• The single-stage bilateral carotid endarterectomy was performed without complications in all twelve patients.
• Patients included those up to age 80 with comorbidities like prior myocardial infarction and stroke.
• Stump pressure monitoring proved a reliable predictor of safe outcomes.

Conclusions:

• Simultaneous bilateral carotid endarterectomy is a safe and effective procedure for carefully selected patients.
• This approach eliminates the need for a second anesthetic and operative procedure, reducing associated risks and delays.
• Single-stage bilateral surgery offers a streamlined and potentially safer management option for bilateral internal carotid artery disease.