Perioperative and late stroke rates of carotid endarterectomy contralateral to carotid artery occlusion - Results from a randomized trial

Background and Purpose-Several previous studies have reported the benefits of carotid endarterectomy (CEA) contralateral to carotid occlusion with mix ed results, but none of these were randomized except for the North American Symptomatic Carotid Endarterectomy Trial. The purpose of this study was to analyze the results of surgery in patients with contralateral carotid arte ry occlusion in a randomized trial in which randomization was done accordin g to the method of closure. Methods-In 399 CEAs (357 patients) that were randomized into primary closur e versus patching, 49 had contralateral occlusion. Strokes were designated as ipsilateral if they arose from the same CEA side and contralateral if th ey arose from the occluded side. A Kaplan-Meier analysis was used to estima te perioperative strokes and stroke-free survival in patients with contrala teral occlusion (group A) versus those without contralateral occlusion (gro up B). Results-Demographic characteristics and mean follow-up for both groups were similar (group A, 40 months; group B, 33 months). Group A had a higher inc idence of contralateral transient ischemic attacks (TIAs) (12.2% versus 0.9 %; P<0.0001), contralateral strokes (2% versus 0%; P=0.025), and combined c ontralateral TIAs/strokes (14.3% versus 0.9%; P<0.0001). The rates for peri operative and all strokes (operative and late) were 2% and 4.1% (2% ipsilat eral and 2% contralateral strokes) for group A and 2.9% and 3.4% (all ipsil ateral) for group B (P=0.60 and 0.85, respectively). The rates for perioper ative and all TIAs were 0% and 14.3% for group A versus 2.6% and 6.3% for g roup B (P=0.918 and P=0.08, respectively). The rates for perioperative and all neurological events (TLA and stroke) were 2% and 18.4% for group A and 5.3% and 9.7% for group B (P=0.27 and 0.113, respectively). The cumulative stroke-free survival rates at 5 years were 84% for group A and 77% for grou p B (P>0.1). The cumulative stroke-free survival rates at 5 years for sympt omatic and asymptomatic patients in group A and group B were also similar. The perioperative and late deaths were similar for both groups (group A, 8% ; group B, 14%). Conclusions-Group A had a higher incidence of contralateral TIAs and stroke s than group B; however, the perioperative and all late stroke rates and su rvival rates of CEA were comparable in patients with and without contralate ral occlusion.