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Simultaneous bilateral carotid endarterectomies

R H Clauss, P V Bole, M Paredes

    Archives of Surgery (Chicago, Ill. : 1960)
    |November 1, 1976
    PubMed
    Summary
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    Bilateral carotid endarterectomy in a single operation is safe for select patients with symptomatic internal carotid artery disease. This approach avoids risks associated with a second anesthetic and surgery, improving patient outcomes.

    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.

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  • 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.