CAROTID-ARTERY SHORTENING - A SAFE ADJUNCT TO CAROTID ENDARTERECTOMY

Purpose: Kinks and coils of the extracranial carotid artery system hav e been described in conjunction with atherosclerotic disease of the in ternal carotid artery. The purpose of this study was to determine whet her adding a carotid artery shortening procedure to carotid endarterec tomy affected perioperative mortality and stroke-morbidity rates or la te restenosis. Methods: A retrospective chart review of all patients w ho concurrently underwent carotid endarterectomy and ipsilateral carot id artery shortening between 1983 and 1992 was performed. Long-term fo llow-up was obtained by contacting the primary physician or patient, a nd carotid artery duplex scans were obtained. Results: One hundred sev en patients were found to have undergone concurrent carotid endarterec tomy and carotid artery shortening. The age range was 47 to 89 years, with 53 female and 54 male patients. Indications for surgery in this g roup were transient ischemic attacks in 28%, stroke in 18%, amaurosis fugax in 7%, and high-grade asymptomatic stenosis in 47%. Shortening p rocedures were performed by use of a variety of techniques at the comp letion of endarterectomy. The combined 30-day mortality and stroke mor bidity rate was 2.7%, with two postoperative deaths and one stroke. In this same period, a total of 1072 carotid endarterectomies were perfo rmed, and the combined 30-day mortality and stroke morbidity rate was 4.0%. During late follow-up there were no ipsilateral strokes, recurre nt symptoms, or significant restenoses. Conclusions: This experience s uggests that the addition of a shortening procedure to carotid endarte rectomy can be performed without increased morbidity and mortality rat es and, when deemed appropriate, is a procedure with which the vascula r surgeon should be familiar.