CAROTID ENDARTERECTOMY CONTRALATERAL TO AN OCCLUDED CAROTID-ARTERY - A RETROSPECTIVE CASE-CONTROL STUDY

Objectives: To analyse whether contralateral occlusion represents an a dditional perioperative risk factor in carotid endarterectomy (CEA), a nd whether long-term survival after surgery in patients with contralat ernal occlusion differs from that of patients without. Design: Retrosp ective clinical study. Setting: Vascular Surgery Unit, Department of S urgery, University of Perugia, Perugia, Italy. Materials: Fifty-five p atients with carotid stenosis and contralateral occlusion undergoing C EA (Group I) were compared with 110 patients (Group II), without contr alateral occlusion selected from a cohort of 367 patients with a paten t contralateral artery, matched for gender, age and ipsilateral sympto ms. Chief outcome measures: Perioperative stroke/death rate at 30 days and minor complications in Group I vs. Group II over a mean follow-up of 38 months. Main results: The perioperative stroke/death rate at 30 days was 0% in Group I and 2.7% in Group II (p = 0.6) while minor com plications amounted to 11% in Group I and 5% in Group II (p = 0.2). Su rvival rates of patients free from stroke, using Kaplan Meier curves, were 79.4% in Group I and 83.3% in Group II (p = 0.4); stroke free rat es were 92.8% and 94.3% in Groups I and II, respectively. The incidenc e of late stroke, fatal or not, in patients who had undergone CEA with contralateral obstruction was the same as in similarly operated patie nts without contralateral obstruction (7% vs. 6%). However, the incide nce of late vascular death, exemplified by a crude rate of 14% vs. 6% (p = 0.1; O.R. = 2.50; C.I. = 0.77-8.25) was greater in patients with contralateral occlusion. Conclusions: In this study, CEA in patients w ith contralateral occlusion was perioperative morbidity/mortality rate . The higher incidence of vascular death in the late follow-up of pati ents with contralateral carotid occlusion, although not statistically significant, could indicate the presence of more severe systemic vascu lar disease.