Carotid revascularization in the presence of contralateral carotid artery occlusion is safe and durable.
OBJECTIVE
Complete occlusion of the contralateral carotid artery has been thought to increase the risk of carotid endarterectomy (CEA). This study was conducted to determine whether contralateral occlusion (CO) leads to a higher rate of complications among patients undergoing CEA or alters long-term outcomes.


METHODS
All CEAs (N = 221) performed at our institution between September 1997 and June 2002 were reviewed. Patients were divided into two groups, i.e., CO and contralateral patency. Statistical analyses were performed using Fisher's exact test for nominal values and the t test for continuous variables. Life-table analyses were performed for patency and survival.


RESULTS
Complete data and follow-up results were available for 170 of the 221 operations performed during the study period. CO was present in 16 cases (9.4%). Preoperative demographic features, indications for surgery, and operative techniques did not vary between study groups; there was increased use of general anesthesia (p = 0.05) in the CO group. No surgical deaths occurred. The perioperative stroke rates were not statistically different between groups (CO group, 6.3%; contralateral patency group, 2.6%; p = 0.39). Long-term patency and stroke-free survival rates at 5 years exceeded 90% and did not vary significantly between groups.


CONCLUSIONS
Patients undergoing CEA with occlusion of the contralateral carotid artery do not have unique preoperative demographic features or indications. Contralateral carotid artery occlusion does not increase risk or alter long-term outcomes after CEA. Carotid revascularization can be safely performed in tertiary military centers.
Wilford Hall Medical Center, Lackland Air Force Base, TX 78236, USA.
Colleen M
CM
Fitzpatrick
Andy C
AC
Chiou
Jeffrey D
JD
DeCaprio
Vikram S
VS
Kashyap
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000503:physiopathology / Q000601:surgery*; D017536:Carotid Artery, Common / Q000503:physiopathology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D015993:Life Tables; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D012449:Safety; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013781:Texas