A 20-year follow-up of internal carotid artery endarterectomy with bifurcation advancement

Background: Carotid artery disease is a frequent cause of transient ischemi c attack and of cerebral infarction. For two last decades, we have been per forming endarterectomy of the internal carotid artery with bifurcation adva ncement. Methods: From January 1977 until December 1997, all records of pat ients who underwent internal carotid artery endarterectomy with bifurcation advancement were reviewed. Data were collected from patients charts and by a questionaire. 160 patients (80.6% men, 19.4% women, average lifetime 65. 1 year) underwent a total of 181 endarterectomies with bifurcation advancem ent. Results: The 30-day mortality was 1.9% and the postoperative stroke pl us death rate 3.1%. The incidence of reoperations was 0.6% with an average follow up of 64 months. In one patient (0.6%), a significant restenosis of the repaired carotid artery was observed. The 1, 5 and 10 years neurologica l death free survival (including early mortality) was 99.3%, 97.2% and 92.5 % and the overall survival (including early mortality) was 96.3%, 78.9% and 59.3% (Kaplan-Meier). Conclusions: The technique of the internal carotid a rtery endarterectomy by bifurcation advancement is a safe and reliable meth od for improvement of cerebral blood supply. Or foreign material or autolog ous vein can thus be avoided. This method offers excellent long term patenc y and has a notable lack of late restenosis.