Surgical treatment of internal carotid artery occlusion.
OBJECTIVE
Nonoperative treatment of recent internal carotid artery (ICA) occlusion is associated with increased recurrent stroke rates. We analyzed our results of carotid endarterectomy (CEA) for treatment of symptomatic recent ICA occlusion to evaluate its feasibility, safety, and outcomes.


METHODS
From 1990 to 2002, all patients with transient ischemic attack (TIA), amaurosis fugax, and minor stroke underwent duplex ultrasound (US) scanning and arteriography to confirm the diagnosis of ICA occlusion. Within 2 weeks of symptom onset, patients underwent operative exploration with attempted CEA. ICA occlusion was detected at preoperative angiography and confirmed at surgery. Patients with extensive ICA plaque not amenable to endarterectomy underwent external CEA with ICA ligation.


RESULTS
Over 12 years, 87 patients with symptomatic ICA occlusion underwent 90 operations for ICA exploration. In 30 patients (18 men, 12 women) with TIA (45%), amaurosis fugax (19%), or minor stroke (36%), CEA to treat ICA occlusion was technically successful. There was 1 postoperative stroke, 2 asymptomatic internal carotid occlusions, and no restenoses (mean follow-up, 26 months; range, 1-93 months). In 57 patients (37 men, 20 women) with TIA (41%), amaurosis fugax (27%), or stroke (32%) in whom CEA was unsuccessful, external CEA was performed. In this group there were no postoperative strokes, 2 asymptomatic external carotid artery occlusions, and 1 restenosis (>70%) (mean follow-up, 22 months; range, 1-73 months). There were no late strokes in either group.


CONCLUSIONS
Operative exploration and endarterectomy to treat symptomatic ICA occlusion is feasible and safe. Patients with symptomatic ICA occlusion should be considered candidates for CEA.
Paty
Philip S K
PS
Institute for Vascular Health and Disease, Albany Medical College, NY 12208, USA.
Adeniyi
John A
JA
Mehta
Manish
M
Darling
R Clement
RC
Chang
Benjamin B
BB
Kreienberg
Paul B
PB
Ozsvath
Kathleen J
KJ
Roddy
Sean P
SP
Shah
Dhiraj M
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color