EXTERNAL CAROTID-ARTERY REPAIR IN CEREBROVASCULAR INSUFFICIENCY

From January 1985 to October 1992 ten patients were submitted to recon struction of the external carotid artery (ECA). Nine were males and on e female with age that ranged from 64 to 74 years, mean 68. All were s ymptomatic due to TIAs in seven and amaurosis fugax in four of this gr oup, previous completed stroke plus TIAs in two and chronic low perfus ion in one. Associated risk factors were smoking (8 pts : 80 %), coron ary disease (5 pts : 50 %), hypertension (4 pts : 40 %), diabetes (4 p ts : 40 %) and peripheral arterial obstructive disease (2 pts : 20 %). All patients were submitted to non invasive (Doppler C.W., Echocolor Doppler) studies as well as angiography. All the patients had an occlu sion of the internal carotid artery (ICA) unilateral and homolateral t o external carotid stenosis in 8 and bilateral in 2 ; in addition thre e patients had a non haemodynamic stenosis of the contralateral ICA. O ne patient had an occlusion of the common carotid artery with collater al supply to the ECA ; nine had severe stenosis of the ECA at the orig in. In one case a homolateral vertebral stenosis was detected as well as a prevertebral contralateral subclavian stenosis in another one. Su rgery was advised to correct amaurosis fugax, to increase external-int ernal collateral supply in order to avoid cerebral ischaemia and prior to contralateral ICA endoarterectomy. All patients were operated upon under general anesthesia ; an endarterectomy with a PTFE patch was pe rformed in 9 cases, while in one a subclavian-ECA bypass was carried o ut using an autologous vein segment. Moreover, obliteration of the ICA stump was associated in two cases, while in one the ICA was detached. An internal shunt was used in 6 patients. There were no postoperative deaths. Two patients died for myocardial infarction 7 months and 3 ye ars postoperatively. During the follow-up (6ms-7ys) all ECA endarterec tomies and the bypass remained patent ; 8 patients (80 %) remained asy mptomatic while in two a contralateral TIA occurred (20 %) before the contralateral carotid lesion was corrected by endarterectomy. They hav e remained asymptomatic ever since. This experience seems to confirm t hat the ECA endarterectomy is usefull in relieving the symptoms in sel ected patients and in removing the source of emboli at the carotid bif urcation ; it presumably allows an increase of the cerebral perfusion, minimizing the risk of contralateral carotid endarterectomy. Moreover this surgery has shown no incidence of neurologic accidents (J Mal Va sc, 1993, 18, pp. 262-264).