title: Contralateral occlusion of the internal carotid artery increases the risk of patients undergoing carotid endarterectomy.
abstract: BACKGROUND
  Controversy exists about whether occlusion of the contralateral internal carotid artery in patients undergoing carotid endarterectomy (CEA) is associated with a worse perioperative prognosis and outcome.
  
  
  METHODS
  A systematic review of electronic information sources was undertaken to identify studies comparing perioperative and early outcomes of CEA in patients with occluded and patent contralateral carotid arteries. The methodologic quality of selected studies was independently appraised by two reviewers. Fixed- and random-effects models were applied to synthesize outcome data.
  
  
  RESULTS
  Our literature search located 46 articles eligible for inclusion in the review and analysis. The total population comprised 27,265 patients having undergone 28,846 CEAs (occluded contralateral artery group, 3120; patent contralateral artery group, 25,726). Patients with an occluded contralateral carotid artery had increased incidence of stroke (odds ratio [OR], 1.65, 95% confidence interval [CI], 1.30-2.09), transient ischemic attack (OR, 1.57, 95% CI, 1.11-2.21), stroke/transient ischemic attack (OR, 1.52; 95% CI, 1.21-1.90), and death (OR, 1.76; 95% CI, 1.19-2.59) ≤30 days of treatment compared with those with a patent contralateral vessel. No difference in the incidence of myocardial infarction between the two groups was identified (OR, 1.45; 95% CI, 0.73-2.89).
  
  
  CONCLUSIONS
  Patients undergoing CEA in the presence of an occluded contralateral carotid artery had increased perioperative and early postoperative risk. Our analysis is limited by heterogeneity in symptom status and practices of intraoperative cerebral protection among the studies. Careful consideration should be given in this subgroup of patients with regard to selection and perioperative and postoperative care to minimize the risk.
authors: Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, United Kingdom. antoniou.ga@hotmail.com
authors: George A
authors: GA
authors: Antoniou
authors: Ganesh
authors: G
authors: Kuhan
authors: George S
authors: GS
authors: Sfyroeras
authors: George S
authors: GS
authors: Georgiadis
authors: Stavros A
authors: SA
authors: Antoniou
authors: David
authors: D
authors: Murray
authors: Ferdinand
authors: F
authors: Serracino-Inglott
mesh_terms: D002343:Carotid Artery, Internal / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome; D014654:Vascular Patency