Outcome of the Contralateral Carotid Artery in Patients Having Undergone Ipsilateral Carotid Endarterectomy: Results of Selective Management

Abstract

Purposes: To evaluate the natural history of the carotid artery in patients who have undergone endarterectomy of the opposite carotid artery, study its relation to new neurologic events by clinical follow-up and serial duplex scanning, review the literature for management guidelines at present, and evaluate the impact on these guidelines from recently published prospective, randomized trials. Methods: A retrospective study of 275 consecutive patients who underwent carotid endarterectomy (CEA) from December 1985 through December 1992. Results: Of 275 patients, 115 were excluded (lost to follow-up, preoperative contralateral carotid occlusion, perioperative death or stroke) leaving 160 patients as the final study group. Progression of contralateral stenosis from <50% to 50-79% occurred in 13/113 patients (11.5%), all asymptomatic; from 50-79% to 80-99% in 10/38 patients (26.3%), (two symptomatic-one transient ischemic attack [TIA] and one stroke-<50% to 80-99% in one patient who was asymptomatic); no patient progressed to total occlusion. All nine patients with an initial contralateral stenosis 80-99% remained asymptomatic prior to subsequent CEA. Neurologic events referable to the contralateral carotid distribution occurred in 10 patients of 160 (6.3%) at a mean of 12.8 months after initial surgery, six TIAs and four strokes, none of which was heralded by TIA. Thus 24 patients showed progression of stenosis, with two (8.3%) manifesting symptoms. Of the other 136 patients without progression of stenosis, eight (5.9%) developed symptoms. Conclusions: Our data and a review of the literature does not support an aggressive approach to the contralateral carotid artery stenosis. Based on NASCET and ACAS, however, new guidelines for management are suggested.