Nonendarterectomy procedures of the carotid artery: A five-year review

Although the efficacy of carotid endarterectomy has been well established, nonendarterectomy procedures of the carotid bifurcation have only sporadica lly been reported. Of 334 consecutive nontraumatic carotid procedures perfo rmed on 321 patients from July 1992 until May 1997, 306 (91.6%) were caroti d endarterectomies, 14 (4.2%) were carotid-subclavian bypasses/transpositio ns, and 14 (4.2%) were nonendarterectomy procedures of the carotid artery. These latter 14 cases (nine females and five males; mean age, 63 years) wer e all symptomatic (neurological or painful mass) and included carotid kink/ coil resection (n = 3; 0.9%), endarterectomy and vertebral transposition (n = 2; 0.6%), carotid aneurysm resection (n = 2; 0.6%), carotid body tumor r esection (n = 2; 0.6%), carotid stump ligation/external endarterectomy (n 1 ; 0.3%), infected/bleeding carotid patch removal with vein graft replacemen t (n = 1; 0.3%), saphenous vein graft replacement (n = 1; 0.3%), carotid di latation for fibromuscular dysplasia (n = 1; 0.3%), and descending aorta to carotid bypass (n = 1; 0.3%). With 30 day follow-up complete for all 334 c arotid operations, 10 perioperative strokes (2.9%) and five deaths (1.5%) o ccurred for a combined stroke/death rate of 3.3 per cent. Of the 14 nonenda rterectomy carotid artery operations, there were no strokes or deaths; with mean follow-up of 13 months, 13 patients (92.9%) are asymptomatic, patent, and disease-free. Three severe transient cranial nerve (CN) neuropraxias ( 21.4%), one myocardial infarction (7.1%), and one late death (mesenteric is chemia at 2 months), however, occurred. Although no statistical differences in stroke, death, and stroke/death occurred between the endarterectomy ver sus the nonendarterectomy group, transient CN injury was more common in the nonendarterectomy group (21.4% versus 4.1%; P = 0.027). Although nonendart erectomy procedures of the carotid bifurcation are infrequently needed, the y seem safe, effective, and indicated in selected patients, despite a highe r incidence of transient CN injury.