Outcome in patients with symptomatic occlusion of the internal carotid artery

Objectives: to assess whether the risk of recurrent ischaemic stroke in pat ients with symptomatic internal carotid artery (ICA) occlusion has changed over the past decades, to determine risk factors for the occurrence of isch aemic stroke and to assess the risk of endarterectomy (CEA) of a severe con tralateral ICA stenosis. Design: retrospective cohort study. Patients and methods: patients with symptomatic ICA occlusion were identifi ed from duplex registry files between 1991 and 1995. Information was obtain ed on vascular risk factors, performance of CEA for a contralateral ICA ste nosis and on recurrence of ischemic stroke. The rate of complications occur ring within 30 days after CEA if the contralateral ICA in patients with sym ptomatic ICA occlusion was compared with the risk of CEA in patients with a symptomatic ICA occlusion and severe contralateral ICA stenosis (symptomati c or asymptomatic). Results: ninety-seven patients were identified. Mean follow-up time was 26 months. The annual risk of (non-)fatal stroke was 5.3% for all strokes (95% CI 2.9%-9.6%) and 3.8% fro ipsilateral stroke (95% CI 1.9%-7.7%). Hyperlip idaemia and severe stenosis of the contralateral ICA were independent risk factors. Twenty-two of 32 patients with a severe stenosis of the contralate ral ICA underwent CEA, of which one patient died and three suffered a minor ischaemic stroke. The perioperative risk of CEA in the control group of 20 patients with asymptomatic contralateral ICA occlusion was 0% (0 of 20). Conclusions: outcome in patients with symptomatic ICA occlusion ha not subs tantially improved over the years. CEA for severe stenosis of the contralat eral ICA carried a relatively high risk in our series, but deserves to be s tudied in a controlled design.