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Carotid Endarterectomy Contralateral to an Occlusion is Not High Risk Even if Shunts are Not Used
Russell H. Samson, MD, Jennifer L. Cline, PhD, David P. Showalter, MD, Michael R. Lepore, Jr., MD, Deepak G. Nair, MD.
Sarasota Vascular Specialists, Sarasota, FL, USA.
OBJECTIVES: Carotid endarterectomy (CEA) in the presence of a contralateral carotid occlusion (CCO) is considered by some to be a high risk procedure, especially if performed without a shunt. In order to evaluate this premise, we have reviewed our 24 year CEA experience and present the subset with a CCO.
METHODS: Between 1988 and 2012, 1967 consecutive CEAs were routinely performed without a shunt, of which 150 had CCOs (111 males (74%), 39 females (26%). 77% of patients were asymptomatic. CEAs were performed by four surgeons using standard techniques (not eversion) under general anesthesia with the blood pressure maintained above 130mmHg. Median cross clamp time (CCT) was 20.5 min. (range 14 to 40 min.).
RESULTS: Five neurological events (3.3%) occurred within 30 days. There were four transient ischemic attacks (TIAs) (2.6%) three occurring in the immediate post-operative period, and one the following day due to an internal carotid occlusion. There was one immediate stroke (0.7%) due to a large atheroembolic shower to both hemispheres. This patient and one patient that suffered a TIA died within 30 days (1.3%). Combined stroke and death rate was 2.0%. During the same period the combined stroke and death rate for patients without CCO was 1.8%.
CONCLUSIONS: Despite nonshunting the combined stroke and death rate of CEA with and without CCO were comparable. Accordingly, CEA with CCO should not be considered a high-risk procedure. Given the low adverse events rates, we do not believe that CCO should be used as an indication for carotid stenting.
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