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Carotid artery endarterectomy in patients with contralateral carotid artery occlusion: Perioperative hazards and late results

  • Original Articles
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Annals of Vascular Surgery

Abstract

The aim of this study was to analyze and compare the perioperative hazards and late results of internal carotid endarterectomy (CEA) in patients with and without contralateral internal carotid artery occlusion. From March 1980 to April 1990, 375 consecutive patients underwent 439 CEAs at the First Department of Vascular Surgery of Padova Medical School. Patients were divided into two groups; group 1 (61 patients) had contralateral internal carotid artery occlusion and group 2 (314 patients) did not (378 CEAs, 64 bilateral). Indications for CEA were similar in both groups. The only significant difference in patient characteristics was a higher rate of previous stroke in group 1 (11% vs. 3%,p < 0.001). General anesthesia, continuous EEG monitoring, selective intraluminal shunt, and arteriotomy closure with a polytetrafluoroethylene patch (PTFE) were used routinely in both groups. An intraluminal shunt was inserted more frequently in group 1 than in group 2 (69% vs. 17%,p <0.001). Major perioperativestroke occurred in one patient in each group (1.7% vs. 0.31%, respectively; NS). Early fatal stroke rates were 0% and 0.95% in groups 1 and 2, respectively (NS). All patients had neurologic examinations and duplex scans every 6 months (range 6 to 118 months; mean 42 months). Kaplan-Meier survival curves were virtually identical in the two groups; the majority of deaths were caused by myocardial infarction and cancer. There were no stroke-related deaths in group 1 as compared with 8.2% in group 2 (NS). New neurologic symptoms appeared in 4.7% of patients in group 1 and 6% in group 2 (NS) whereas the late stroke rates were 0% and 3.1%, respectively (NS). Restenosis was observed in two and three patients in groups 1 and 2, respectively (NS). In conclusion, CEA for ulcerated or stenotic lesions of the internal carotid artery in patients with contralateral carotid occlusion is associated with very low early and long-term neurologic morbidity and mortality, similar to findings in patients who undergo CEA with a patent contralateral carotid artery.

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References

  1. Moore DJ, Modi JR, Finch WJ, et al. Influence of the contralateral carotid artery on neurological complications following carotid endarterectomy. J Vasc Surg 1984;1:409–414.

    Article  PubMed  Google Scholar 

  2. Andreassian B, Bouttier S, Nussaume O, et al. Evaluation preoperatoire du risque neurologique en chirurgie carotidienne. In Kieffer E, Natali J, eds. Aspects Techniques de la Chirurgie Carotidienne. Paris: AERCV, 1987, pp 57–59.

    Google Scholar 

  3. Lesage R, Paris E, Koskas F, et al. Surgical reconstruction of the internal carotid artery with contralateral occlusion with-out use of shunt. Ann Vasc Surg 1991;5:55–60.

    Article  PubMed  Google Scholar 

  4. Sachs SM, Fulenwider JT, Smith RB, et al. Does contralateral carotid occlusion influence neurologic fate of carotid endarterectomy? Surgery 1984;96:839–844.

    PubMed  Google Scholar 

  5. Friedman SG, Riles TS, Lamparello PJ, et al. Surgical therapy for the patient with internal carotid artery occlusion and contralateral stenosis. J Vasc Surg 1987;5:856–861.

    Article  PubMed  Google Scholar 

  6. Mackey WC, O'Donnell TF Jr, Callow AD. Carotid endarterectomy contralateral to an occluded carotid artery: Perioperative risk and late results. J Vasc Surg 1990;11:778–785.

    Article  PubMed  Google Scholar 

  7. Hammacher ER, Eikelboom DC, Bast TJ, et al. Surgical treatment of patients with a carotid artery occlusion and a contralateral stenosis. J Cardiovasc Surg 1984;25:513–517.

    Google Scholar 

  8. La Muraglia GM, Darling RC, Brewster DC, et al. Neurologic sequelae with internal carotid artery occlusion. Arch Surg 1987;122:432–435.

    PubMed  Google Scholar 

  9. Fritz VU, Voll CL, Levien LJ. Internal carotid occlusion: Clinical and therapeutical implications. Stroke 1985;16:940–944.

    PubMed  Google Scholar 

  10. Nicholls SC, Bergelin R, Strandness DE. Neurological sequelae of unilateral carotid artery occlusion: Immediate and late results. J Vasc Surg 1989;10:542–548.

    Article  PubMed  Google Scholar 

  11. Nicholls SC, Kohler TR, Bergelin RO, et al. Carotid artery occlusion: Natural history. J Vasc Surg 1986;4:479–485.

    Article  PubMed  Google Scholar 

  12. Furlan AJ, Whisnant JP, Baker HL, et al. Long-term prognosis and carotid artery occlusion. Neurology 1980;30:986–988.

    PubMed  Google Scholar 

  13. Cote R, Barnett HJM, Taylor DW, et al. Internal carotid occlusion: A prospective study. Stroke 1983;14:898–902.

    PubMed  Google Scholar 

  14. Grillo P, Patterson RH Jr. Occlusion of the carotid artery: Prognosis (natural history) and the possibilities of surgical revascularization. Stroke 1975;6:17–20.

    PubMed  Google Scholar 

  15. Hertzer NR, Flanagan RA, O'Hara PJ, et al. Surgical versus nonoperative treatment of symptomatic carotid stenosis. Ann Surg 1986;204:154–162.

    PubMed  Google Scholar 

  16. Fields WS, Lemak NA. Joint study of extracranial arterial occlusion: Internal carotid artery occlusion. JAMA 1976;235: 2734–2738.

    Article  PubMed  Google Scholar 

  17. Ott DA, Cooley DA, Chapa L, et al. Carotid endarterectomy without temporary intraluminal shunt: Study of 308 consecutive operations. Ann Surg 1980;191:708–714.

    PubMed  Google Scholar 

  18. Baker WH, Littooy FN, Hayes AC, et al. Carotid endarterectomy without a shunt: The control series. J Vasc Surg 1984;1:50–56.

    Article  PubMed  Google Scholar 

  19. Littooy FN, Halstuk KS, Mamdani M, et al. Factors influencing morbidity of carotid endarterectomy without a shunt. Am Surg 1984;50:350–353.

    PubMed  Google Scholar 

  20. Sillesen H, Schroeder T, Rasmussen L, et al. Carotid endarterectomy in patients with carotid artery occlusion and a contralateral carotid artery stenosis: Perioperative risk and late results. Eur J Vasc Surg 1987;1:85–89.

    Article  PubMed  Google Scholar 

  21. Calhorm TR, Kitten CM. Proximal shunt dissection: A potential problem in carotid endarterectomy. Texas Heart Inst J 1985;12:359–361.

    Google Scholar 

  22. McIntyre KE, Ely RL III, Malme JM, et al. External carotid artery reconstruction: Its role in the treatment of cerebral ischemia. Am J Surg 1985;150:58–64.

    Article  PubMed  Google Scholar 

  23. Dos M, Hertzer NR, Ratliff NB, et al. Recurrent carotid stenosis: A five-year series of 65 reoperations. Ann Surg 1985;202:28–35.

    PubMed  Google Scholar 

  24. Piepgras DG, Sundt TM, Maish WR, et al. Recurrent carotid stenosis: Results and complication of 57 operations. Ann Surg 1986;203:205–213.

    PubMed  Google Scholar 

  25. Deriu GP, Ballotta E, Bonavina L, et al. The rationale for patch graft angioplasty after carotid endarterectomy: Early and long-term follow-up. Stroke 1986;15:972–979.

    Google Scholar 

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Authors and Affiliations

  1. Department of Vascular Surgery, Internal Medicine, University of Padova, Padova, Italy

    Giovanni P. Deriu MD, Lorenza Franceschi MD, Domenico Milite MD, Alessio Calabro MD, Aldo Saia MD, Franco Grego MD, Diego Cognolato MD, Paolo Frigatti MD & Mario Diana MD

  2. Department of Neurology, University of Padova, Padova, Italy

    Giovanni P. Deriu MD, Lorenza Franceschi MD, Domenico Milite MD, Alessio Calabro MD, Aldo Saia MD, Franco Grego MD, Diego Cognolato MD, Paolo Frigatti MD & Mario Diana MD

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  1. Giovanni P. Deriu MD
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  2. Lorenza Franceschi MD
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  3. Domenico Milite MD
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  4. Alessio Calabro MD
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  5. Aldo Saia MD
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  6. Franco Grego MD
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  7. Diego Cognolato MD
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  8. Paolo Frigatti MD
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  9. Mario Diana MD
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Deriu, G.P., Franceschi, L., Milite, D. et al. Carotid artery endarterectomy in patients with contralateral carotid artery occlusion: Perioperative hazards and late results. Annals of Vascular Surgery 8, 337–342 (1994). https://doi.org/10.1007/BF02132994

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