title: Clinical Outcomes after Carotid Endarterectomy in Patients with Contralateral Carotid Occlusion.
abstract: BACKGROUND
  Severe carotid stenosis is typically treated with carotid endarterectomy (CEA), but there is debate about the safety of this procedure in patients with contralateral carotid occlusion (CCO). To compare 30-day outcomes after CEA in patients with severe carotid stenosis or without CCO.
  
  
  METHODS
  This retrospective, single-institution analysis included 434 patients who underwent CEA. All CEAs were performed under general anesthesia, and carotid shunts were used in 32 patients. Patients were categorized into 2 groups according to patency of the contralateral carotid artery: groups I (no CCO, n = 394) and II (with CCO, n = 40). Demographics, preoperative symptomatic status, and frequency of early (<30 days) symptomatic neurologic complications and death were compared.
  
  
  RESULTS
  Total mortality after CEA was 1.6% (n = 7), 7 and 0 in groups I and II, respectively (P = 0.39). Overall stroke rate was 3.5% (n = 15), 15 and 0 in groups I and II, respectively (P = 0.20). Rate of transient ischemic attacks was 1.4% (n = 6), 5 and 1 in groups I and II, respectively (P = 0.37). Symptomatic group I patients had a higher rate of stroke and/or death (6.7% vs. 0%) (P = 0.85). In asymptomatic patients, the stroke and/or death rate was higher in group II (3.4% vs. 8.3%, P < 0.05). In group II, the frequency of shunt placement was higher (3% vs. 53%, P = 0.001). At mean follow-ups of 75.4 ± 47.5 months (group I) and 72.7 ± 49.9 months (group II), 157 and 13 additional deaths had occurred in groups I and II, respectively (P = 0.21).
  
  
  CONCLUSIONS
  Patients with CCO who undergo CEA do not appear to be at increased risk for perioperative incidence of stroke and/or death, or any neurologic event.
authors.affiliation: Department of Vascular Surgery, Universitary Hospital Lugo, La Coruña, Spain. Electronic address: framan1@hotmail.com.
authors.forename: Carola Rubio
authors.initials: CR
authors.lastname: Taboada
authors.affiliation: Department of Vascular Surgery, Universitary Hospital Lugo, La Coruña, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Duran Mariño
authors.affiliation: Department of Vascular Surgery, Universitary Hospital Lugo, La Coruña, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Garcia Colodro
authors.affiliation: Department of Vascular Surgery, Universitary Hospital Lugo, La Coruña, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Pena Holguin
authors.affiliation: Department of Vascular Surgery, Universitary Hospital Lugo, La Coruña, Spain.
authors.forename: Eva Lucia
authors.initials: EL
authors.lastname: Martinez Gallego
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency