Carotid endarterectomy contralateral to carotid artery occlusion: analysis from a randomized study.
OBJECTIVE
Many studies have reported the benefits of carotid endarterectomy (CEA) contralateral to an occluded internal carotid artery (ICA), with varying results. This study analyzed perioperative and late outcomes in a recent trial in which patients were randomized to carotid eversion endarterectomy (CEE) or traditional CEA with patching (CEAP).


METHODS
In 336 primary CEAs (310 patients) 68 were contralateral to an occluded ICA (group I). The remaining 268 CEAs served as control group (group II). All patients underwent clinical follow-up and duplex ultrasonography at 1, 6, and 12 months and every year thereafter. Endpoints of the study were early and late neurological events, and deaths.


RESULTS
Group I had a significantly higher incidence of perioperative electroencephalic changes and need for shunting. The perioperative stroke rate in group I was almost three times as high as in group II, but the difference was not significant. Similarly, the perioperative minor neurological event and death rates, as with the cumulative stroke-free and survival rates at 1, 3, and 5 years, were comparable in the two groups.


CONCLUSIONS
CEA contralateral to an occluded ICA can be implemented with perioperative stroke and mortality rates and late stroke-free and survival rates comparable to CEA with no contralateral ICA occlusion.
Ballotta
Enzo
E
Vascular Surgery Section, Department of Medical and Surgical Sciences, University of Padua, School of Medicine, Policlinico Universitario, Via N. Giustiniani 2, 35128 Padua, Italy. enzo.ballotta@unipd.it
Da Giau
Giuseppe
G
Baracchini
Claudio
C
D000368:Aged; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology / Q000401:mortality