Fate of the carotid artery contralateral to endarterectomy

Abstract

The management of internal carotid artery disease contralateral to endarterectomy is highly controversial. At our institution we have adopted an approach by which patients are followed with serial duplex scanning after unilateral carotid endarterectomy. Surgery on the contralateral carotid artery is recommended for patients who exhibit ischemic neurologic symptoms or develop an 80% to 99% carotid stenosis. This strategy is based on previous reports that have documented an increased incidence of strokes in these two groups of patients. As a result, 40 patients among a study population of 200 underwent carotid endarterectomy on the originally unoperated side. The current study reviews the natural history of the patients who were followed without or before operation of the contralateral carotid artery in an attempt to identify other cohorts at increased risk for stroke. Patients were followed for up to 126 months after unilateral carotid endarterectomy (mean, 54 months). Six patients were lost to follow-up (3.0%). By life-table analysis the estimated mean annual rate of progression to greater than or equal to 50% diameter reduction was 3.9% and 1.2% for progression to greater than or equal to 80% stenosis. Only two patients went on to occlusion during follow-up. Neurologic events referable to the contralateral carotid distribution were infrequent. The estimated mean annual rate was 2.9% for transient ischemic attacks and less than 0.8% for strokes. Case history review of the six patients who had strokes during follow-up suggested that only one patient may have benefited from carotid endarterectomy. Conservative management with serial duplex scanning of the unoperated, contralateral carotid artery appears appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)