SEVERE BILATERAL CAROTID STENOSIS

The indication for carotid endarterectomy in patients with unilateral stenotic lesions as well as the operative risk in patients with bilate ral disease is still controversial among experts. We performed a retro spective analysis in our patients with bilateral carotid endarterectom y. 578 patients underwent carotid endarterectomy at our institution fr om 1986-1992: 54 patients (9.3%) had bilateral carotid disease. 30% of these patients were asymptomatic and 16% had symptoms from both sides . Surgical results concerning the optimal restoration of blood supply (75%) and the occurence of recurrent stenosis (80%) were comparable fo r patients with unilateral and bilateral carotid endarterectomy. On th e contrary, in patients with bilateral carotid disease, both the opera tive morbidity (2.8%) and mortality (1.8%) were increased as compared to the total study population (1.9% and 0.45% resp.). Carotid endarter ectomy is very effective in preventing stroke especially in patients w ith multiple vessel disease as compared to the natural history of thes e lesions.