title: Clinical Outcomes of Carotid Endarterectomy in Symptomatic and Asymptomatic Patients with Ipsilateral Intracranial Stenosis.
abstract: OBJECTIVE
  The risk of perioperative stroke and the benefits of carotid endarterectomy (CEA) remain uncertain in the case of an ipsilateral intracranial stenosis. The aim of this observational study was to analyze the early and late outcomes of CEA in patients with a carotid tandem lesion (CTL), defined as a severe stenosis at the bifurcation with any concomitant lesion ≥50 % involving the intracranial portion of the ipsilateral internal carotid artery or the main trunk of the anterior or middle cerebral artery.
  
  
  METHODS
  From 2000 to 2009, 1143 patients underwent CEA for symptomatic or asymptomatic extracranial carotid stenosis according to the NASCET and ACAS recommendations, respectively. CTLs were diagnosed in 219 patients (19.2 %) by extracranial and transcranial color-coded Doppler sonography combined with noninvasive brain imaging studies. The primary endpoints of the study were perioperative (30-day) stroke and death, and any ipsilateral ischemic adverse events during the follow-up, which ranged from 0.1 to 10 years (mean 4.9 ± 3.3 years). The rates of the primary endpoints were compared between patients with (group I) and without CTL (group II).
  
  
  RESULTS
  Overall, 219 CEAs were performed in group I and 924 in group II. Nearly two in three of the carotid lesions (777 of 1143, 68 %) were symptomatic at presentation (62.1 % in group I vs 69.4 % in group II; p = 0.03), with a 23.8 % rate of stroke (21.9 % in group I vs 24.2 % in group II; p = 0.85). There were 2 (0.9 %) perioperative ipsilateral strokes in group I and 5 (0.5 %) in group II (p = 0.62), and no deaths. The 5-year ipsilateral stroke-free, any stroke-free, and overall survival rates did not differ significantly between patients with and without CTL.
  
  
  CONCLUSIONS
  This study has shown that patients with and without CTL who underwent CEA had a similar occurrence of perioperative adverse events (probably due to the extremely low incidence of perioperative complications) and comparable late outcomes, suggesting that the presence of CTL does not justify refusing CEA for patients who could benefit from it.
authors.affiliation: The Vascular Surgery Group, 2nd Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, Via N. Giustiniani, 2, 35128, Padua, Italy. enzo.ballotta@unipd.it.
authors.forename: Enzo
authors.initials: E
authors.lastname: Ballotta
authors.affiliation: The Vascular Surgery Group, 2nd Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, Via N. Giustiniani, 2, 35128, Padua, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Toniato
authors.affiliation: The Vascular Surgery Group, 2nd Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, Via N. Giustiniani, 2, 35128, Padua, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Da Roit
authors.affiliation: Department of Neurosciences, University of Padua, School of Medicine, Padua, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Baracchini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D058070:Asymptomatic Diseases / Q000628:therapy; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000601:surgery*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000601:surgery; D018572:Disease-Free Survival; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D059906:Neuroimaging; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology*; D015996:Survival Rate; D018615:Ultrasonography, Doppler, Color