Top

Published in:

01-11-2005 | Clinical Research

Is Contralateral Carotid Artery Occlusion a Risk Factor for Carotid Endarterectomy?

Authors: Franco Grego, MD, Michele Antonello, MD, Sandro Lepidi, MD, Massimiliano Zaramella, MD, Elisa Galzignan, MD, Mirko Menegolo, MD, Giovanni P. Deriu, MD

Published in: Annals of Vascular Surgery | Issue 6/2005

Abstract

Occlusion of the contralateral internal carotid artery (ICA) is considered to have a significant impact on the outcome of carotid endarterectomy (CEA). The purpose of this study was to review one center’s experience concerning CEA opposite an occluded ICA, to see whether results differed from those obtained in patients with patent contralateral ICA in terms of relevant neurologic complication rate (RNCR, fatal + disabling stroke), stroke-free rate, and survival rate. From January 1997 to December 2002, 1,381 patients underwent a total of 1,445 CEAs at the Department of Vascular Surgery of Padua University. Patients were divided into two groups: group A included 144 patients with occlusion of the contralateral ICA and group B consisted of 1,237 patients with a patent contralateral ICA. There was no postoperative mortality in patients of group A, while in group B, two patients died as a result of myocardial infarction and cardiac failure and one died as a direct result of perioperative stroke. Postoperative disabling strokes occurred in one (0.7%) patient in group A and 10 (0.8%) patients in group B (p > 0.5). At 72 months, there were no statistical differences between the two groups in terms of RNCR, stroke-free rate, and late death. Our results show that contralateral carotid occlusion does not reduce the safety of CEA. The efficacy in terms of RNCR, stroke-free rate, and late survival is no different in patients with contralateral carotid occlusion.

North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis. N Engl J Med 1991;325:445-453

Executive Committee for the Asymptomatic Study. Endarterectomy for asymptomatic carotid stenosis. JAMA 1995;273:1421-1428

Fields WS, Lemak NA. Joint study of extracranial arterial occlusion, internal carotid artery occlusion. JAMA 1976;235:2734-2738.CrossRefPubMed

Nicholls SC, Kohler TR, Bergelin RO, Primozich JF, Lawrence RL, Strandness DE. Carotid artery occlusion: natural history. J Vasc Surg 1986;4:479-485CrossRefPubMed

Mattos MA, Barkmeier LD, Hodgson KJ, Ramsey DE, Sumner DS. Internal carotid occlusion: operative risks and long-term stroke rates after controlateral carotid endarterectomy. Surgery 1992;112:670-680PubMed

Mackey WC, O’Donnell TF Jr, Callow AD. Carotid endarterectomy controlateral to an occluded carotid artery: perioperative risk and late results. J Vasc Surg 1990;11:778-785CrossRefPubMed

Aungst M, Gahtan V, Berkowitz H, Roberts AB, Kerstein MD. Carotid endarterectomy outcome is not affected in patients with a controlateral carotid occlusion. Am J Surg 1998;176:30-33CrossRefPubMed

McCarthy WJ, Wang R, Pearce WH, Flinn WR, Yao JST. Carotid endarterectomy with an occluded contralateral carotid artery. Am J Surg 1993;166:168-172PubMed

DaSilva AF, McCollum P, Szymanska T, DeCossart L. Prospective study of carotid endarterectomy and controlateral carotid occlusion. Br J Surg 1996;83:1370-1372PubMed

10.

Deriu GP, Milite D, Damiani N, et al. Carotid endarterectomy without angiography: a prospective randomised pilot study. Eur J Vasc Endovasc Surg 2000;20:250-253CrossRefPubMed

11.

Nicolaides AN, Shifrin EG, Bradbury A, et al. Angiographic and duplex grading of internal carotid stenosis: can we overcome the confusion? J Endovasc Surg 1996;3:158-165CrossRefPubMed

12.

Deriu G, Milite D, Mellone G, Cognolato D, Frigatti P, Grego F. Clamping ischaemia, threshold ischaemia and delayed insertion of the shunt during carotid endarterectomy with patch. J Cardiovasc Surg 1999;40:1-6

13.

Baker JD, Rutherford RB, Bernstein EF, et al. Suggested standards for reports dealing with cerebrovascular disease. J Vasc Surg 1988;8:721-729CrossRefPubMed

14.

Hammacher ER, Eikelboom BC, Bast TJ, DeGeest R, Vermeulen FEE. Surgical treatment of patients with a carotid artery occlusion and a contralateral stenosis. J Cardiovasc Surg 1984;25:513-517

15.

Aungst M, Gathan V, Berkowitz H, Roberts AB, Kerstein MD. Carotid endarterectomy outcome is not affected in patients with a contralateral carotid artery occlusion. Am J Surg 1998;176:30-33CrossRefPubMed

16.

McCarthy WJ, Wang R, Pearce WH, Flinn WR, Yao JST. Carotid endarterectomy with an occluded contralateral carotid artery. Am J Surg 1993;166:168-172PubMed

17.

Jacobowitz G, Adelman MA, Riles TS, Lamparello PJ, Imparato AM. Long-term follow-up of patients undergoing carotid endarterectomy in the presence of a contralateral occlusion. Am J Surg 1995;170:165-167CrossRefPubMed

18.

Cao P, Giordano G, DeRango P, Ricci S, Zannetti S, Moggi L. Carotid endarterectomy contralateral to an occluded carotid artery: a retrospective case-control study. Eur J Vasc Endovasc Surg 1995;10:16-22CrossRefPubMed

19.

AbuRahma AF, Robinson P, Holt SM, Herzog TA, Mowery NT. Perioperative and late stroke rates of carotid endarterectomy contralateral to carotid artery occlusion. Results from a randomized trial. Stroke 2000;31:1566-1571PubMed

20.

Pulli R, Dorigo W, Barbanti E, et al. Carotid endarterectomy with contralateral carotid artery occlusion: is this a higher risk subgroup? Eur J Vasc Endovasc Surg 2002;24:63-68CrossRefPubMed

21.

Adelmann MA, Jacobwitz GR, Riles TS, et al. Carotid endarterectomy in the presence of a contralateral occlusion: a review of 315 cases of a 27-year experience. Cardiovasc Surg 1995;3:307-312CrossRefPubMed

22.

Nicholls SC, Bergelin R, Strandness DE. Neurologic sequelae of unilateral carotid artery occlusion: immediate and late. J Vasc Surg 1989;19:542-548CrossRef

23.

Lesage R, Paris E, Koskas F, Bahanini A, Kieffer E. Surgical reconstruction of the internal carotid artery with contralateral occlusion without use of shunt. Ann Vasc Surg 1991;5:55-60CrossRefPubMed

24.

Deriu GP, Franceschi L, Milite D, et al. Carotid endarterectomy in patients with contralateral carotid artery occlusion: perioperative hazards and late results. Ann Vasc Surg 1994;8:337-342CrossRefPubMed

25.

McIntyre KE, Ely RL III, Malone JM, Berhard VM, Goldstone J. External carotid artery reconstruction: its role in the treatment of cerebral ischemia. Am J Surg 1985;150:58-64CrossRefPubMed

26.

Deriu GP, Grego F. Carotid endarterectomy: looking for the gold standard. Acta Chir Belg 2002;102:427-429PubMed

27.

Barnston NM, Strong AJ, Symon L. Extracellular potassium activity, evoked potential and tissue blood flow: relationship during progressive ischaemia in baboon cerebral cortex. J Neurol Sci 1977;32:305-321CrossRefPubMed

28.

Gewertz BL, McCafrey MT. Intraoperative monitoring during carotid endarterectomy. Curr Probl Surg 1987;24:475-532CrossRefPubMed

29.

Deriu GP, Ballotta E, Bonavina L, et al. The rationale for patch graft angioplasty after carotid endarterectomy; early and long term results. Follow-up. Stroke 1984;15:972-979PubMed

30.

Counsell CE, Salinas R, Naylor R, Warlow P. A systematic review of the randomised trials of carotid patch angioplasty in carotid endarterectomy. Eur J Vasc Endovasc Surg 1997;13:345-354CrossRefPubMed

31.

Hertzer NR, Beven EG, Young JR, O’Hara PJ, Graor RA, Rushhaupt WF III. Incidental asymptomatic carotid bruits in patients scheduled for peripheral vascular reconstruction: results of cerebral and coronary angiography. Surgery 1984;96:535-543.PubMed

Title: Is Contralateral Carotid Artery Occlusion a Risk Factor for Carotid Endarterectomy?
Authors: Franco Grego, MD
Michele Antonello, MD
Sandro Lepidi, MD
Massimiliano Zaramella, MD
Elisa Galzignan, MD
Mirko Menegolo, MD
Giovanni P. Deriu, MD
Publication date: 01-11-2005
Publisher: Springer-Verlag
Published in: Annals of Vascular Surgery / Issue 6/2005
Print ISSN: 0890-5096
Electronic ISSN: 1615-5947
DOI: https://doi.org/10.1007/s10016-005-7719-2

At a glance: The STEP trials

Springer Medicine

Is Contralateral Carotid Artery Occlusion a Risk Factor for Carotid Endarterectomy?

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2005

Gadolinium-Enhanced Versus Time-of-Flight Magnetic Resonance Angiography: What Is the Benefit of Contrast Enhancement in Evaluating Carotid Stenosis?

Carotid Artery Stenting in Octogenarians: Is It Too Risky?

Aneurysm of the Popliteal Artery in Neurofibromatosis

Removing the Infected Aortofemoral Graft Using a Two-Stage Procedure with a Delay Between the Stages

Implications of Early Failure of Superficial Femoral Artery Endoluminal Interventions

Prospective Randomized Study on Asymptomatic Severe Carotid Stenosis and Perioperative Stroke Risk in Patients Undergoing Major Vascular Surgery: Prophylactic or Deferred Carotid Endarterectomy?