A 20-year follow-up of internal carotid artery endarterectomy with bifurcation advancement.
BACKGROUND
Carotid artery disease is a frequent cause of transient ischemic attack and of cerebral infarction. For two last decades, we have been performing endarterectomy of the internal carotid artery with bifurcation advancement.


METHODS
From January 1977 until December 1997, all records of patients who underwent internal carotid artery endarterectomy with bifurcation advancement were reviewed. Data were collected from patients charts and by a questionnaire. 160 patients (80.6% men, 19.4% women, average lifetime 65.1 year) underwent a total of 181 endarterectomies with bifurcation advancement.


RESULTS
The 30-day mortality was 1.9% and the postoperative stroke plus death rate 3.1%. The incidence of reoperations was 0.6% with an average follow up of 64 months. In one patient (0.6%), a significant restenosis of the repaired carotid artery was observed. The 1, 5 and 10 years neurological death free survival (including early mortality) was 99.3%, 97.2% and 92.5% and the overall survival (including early mortality) was 96.3%, 78.9% and 59.3% (Kaplan-Meier).


CONCLUSIONS
The technique of the internal carotid artery endarterectomy by bifurcation advancement is a safe and reliable method for improvement of cerebral blood supply. Or foreign material or autologous vein can thus be avoided. This method offers excellent long term patency and has a notable lack of late restenosis.
Nett
P C
PC
Clinic of Cardiovascular Surgery, University Hospital, Zurich, Switzerland. philipp.nett@chi.usz.ch
Zund
G
G
Prêtre
R
R
Niederhouser
U
U
Vogt
P R
PR
Turina
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000601:surgery; D002343:Carotid Artery, Internal / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome