Carotid endarterectomy contralateral to carotid occlusion: Analysis from a randomized study.

ABSTRACT. Background and aims . Many studies have reported on the benefits of carotid endarterectomy (CEA) contralateral to an occluded internal carotid artery (ICA) with divergent results. This study analyses perioperative and late outcomes of CEA in patients with contralateral ICA occlusion emerging from a recent trial in which patients were randomised to two different surgical techniques, i.e. carotid eversion endarterectomy (CEE) or traditional CEA with patching (CEAP). Patients/Methods. In 336 primary CEAs (310 patients), that were randomised into CEE versus CEAP, 68 were contralateral to an occluded ICA (group I). The remaining 268 CEAs served as control group (group II). All patients underwent clinical follow-up and duplex ultrasonography at 1,6 and 12 months, and every year thereafter. Endpoints of the study were early and late neurologic events, and deaths. Results. Demographics, risk factors, clinical presentation, indications for surgery and mean follow-up were comparable in the two groups. Group I had a statistically higher incidence of perioperative electroencephalic changes (p< .0001) and the need for shunting (p< .0001). Although the perioperative stroke rate in group I was almost 3 times higher than in group II, the difference was not significant. Similarly, the perioperative minor neurologic event and death rates, like the cumulative stroke-free and survival rates at 1,3 and 5 years, were comparable in the two groups. Conclusions. CEA contralateral to an occluded ICA can be implemented with perioperative stroke and mortality rates and late stroke-free and survival rates comparable to CEA with no contralateral ICA occlusion.