Clinical Outcomes after Carotid Endarterectomy in Patients with Contralateral Carotid Occlusion.

BACKGROUND: Severe carotid stenosis is typically treated with carotid endarterectomy (CEA), but there is debate about the safety of this procedure in patients with contralateral carotid occlusion (CCO). To compare 30-day outcomes after CEA in patients with severe carotid stenosis or without CCO. METHODS: This retrospective, single-institution analysis included 434 patients who underwent CEA. All CEAs were performed under general anesthesia, and carotid shunts were used in 32 patients. Patients were categorized into 2 groups according to patency of the contralateral carotid artery: groups I (no CCO, n = 394) and II (with CCO, n = 40). Demographics, preoperative symptomatic status, and frequency of early (<30 days) symptomatic neurologic complications and death were compared. RESULTS: Total mortality after CEA was 1.6% (n = 7), 7 and 0 in groups I and II, respectively (P = 0.39). Overall stroke rate was 3.5% (n = 15), 15 and 0 in groups I and II, respectively (P = 0.20). Rate of transient ischemic attacks was 1.4% (n = 6), 5 and 1 in groups I and II, respectively (P = 0.37). Symptomatic group I patients had a higher rate of stroke and/or death (6.7% vs. 0%) (P = 0.85). In asymptomatic patients, the stroke and/or death rate was higher in group II (3.4% vs. 8.3%, P < 0.05). In group II, the frequency of shunt placement was higher (3% vs. 53%, P = 0.001). At mean follow-ups of 75.4 ± 47.5 months (group I) and 72.7 ± 49.9 months (group II), 157 and 13 additional deaths had occurred in groups I and II, respectively (P = 0.21). CONCLUSIONS: Patients with CCO who undergo CEA do not appear to be at increased risk for perioperative incidence of stroke and/or death, or any neurologic event.

[Results of carotid endarterectomy in elderly patients]. / Resultados de la endarterectomía carotídea en pacientes ancianos.

INTRODUCTION: Forty-five per cent of stoke patients have a surgically accessible stenosis. The objective of our study is to describe the response to carotid endarterectomy (EA) in patients of advanced age compared to younger ones. MATERIAL AND METHOD: Retrospective evaluation of the clinical history of all patients who underwent an endarterectomy in a tertiary hospital between January 1995 and December 2006. The patients were grouped into those 75 years or older and those less than this age. The incidence of peri-operative complications in the first month after surgery, and the long-term mortality was evaluated using a survival analysis. RESULTS: Data were collected on 147 EA in 134 patients of 75 years or more, and on 201 EA in 177 patients less than 75 years-old. The incidence of peri-operative complications was similar in both groups, with a mortality of 2% in the older age group and a stroke incidence of 2.6% (half transient ischaemic accidents). The older patients had a mean follow-up of 4.1 years, with a survival of 86% at one year and 54% at 5 years and with the main cause of death being heart disease. CONCLUSIONS: Carotid EA is a safe and effective technique for the treatment of extracranial carotid stenosis in the elderly, having the same peri-operative morbidity and mortality as younger ones. Age must not affect our therapeutic attitude, although an exhaustive cardiology study must be made in the elderly prior to the operation.