Carotid Endarterectomy in Patients With Contralateral Carotid Occlusion

FREDRIC B. MEYER, NICOLEE C. FODE, W. RICHARD MARSH, DAVID G. PIEPGRAS

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

In this study, we assessed the results of carotid endarterectomy in 357 patients with a carotid stenosis and contralateral carotid occlusion. The overall major neurologic morbidity was 0.6%, and the minor morbidity was 1.1%. The causes of four perioperative deaths (1.1%) were myocardial infarction in two patients, ruptured abdominal aortic aneurysm in one, and respiratory complications in one. Therefore, an excellent result was achieved in 97.2% of patients. With occlusion of the carotid artery for the endarterectomy, 165 patients (46%) had appreciable attenuation in intraoperative electro-encephalographic findings and a decrease in cerebral blood flow to approximately 10 ml/100 g of brain tissue per min that necessitated placement of a shunt. This high percentage of profound electroencephalographic and blood flow changes during carotid occlusion suggests that the potential for collateral blood flow in this group of patients is minimal. These results demonstrate that a carotid endarterectomy can be performed at low risk in patients with a contralateral carotid occlusion. We advocate annual noninvasive carotid testing for patients with asymptomatic carotid stenosis and contralateral carotid occlusion. If progression of the stenosis is evident, a prophylactic endarterectomy should be considered because these patients may have a higher risk for cerebral infarction than do patients with a unilateral asymptomatic stenosis.

Original languageEnglish (US)
Pages (from-to)337-342
Number of pages6
JournalMayo Clinic Proceedings
Volume68
Issue number4
DOIs
StatePublished - 1993

Fingerprint

Carotid Endarterectomy
Carotid Stenosis
Cerebrovascular Circulation
Pathologic Constriction
Morbidity
Aortic Rupture
Endarterectomy
Cerebral Infarction
Abdominal Aortic Aneurysm
Carotid Arteries
Nervous System
Myocardial Infarction
Brain

ASJC Scopus subject areas

  • Medicine(all)

Cite this

MEYER, FREDRIC. B., FODE, NICOLEE. C., MARSH, W. RICHARD., & PIEPGRAS, DAVID. G. (1993). Carotid Endarterectomy in Patients With Contralateral Carotid Occlusion. Mayo Clinic Proceedings, 68(4), 337-342. https://doi.org/10.1016/S0025-6196(12)60127-X

Carotid Endarterectomy in Patients With Contralateral Carotid Occlusion. / MEYER, FREDRIC B.; FODE, NICOLEE C.; MARSH, W. RICHARD; PIEPGRAS, DAVID G.

In: Mayo Clinic Proceedings, Vol. 68, No. 4, 1993, p. 337-342.

Research output: Contribution to journalArticle

MEYER, FREDRICB, FODE, NICOLEEC, MARSH, WRICHARD & PIEPGRAS, DAVIDG 1993, 'Carotid Endarterectomy in Patients With Contralateral Carotid Occlusion', Mayo Clinic Proceedings, vol. 68, no. 4, pp. 337-342. https://doi.org/10.1016/S0025-6196(12)60127-X
MEYER, FREDRIC B. ; FODE, NICOLEE C. ; MARSH, W. RICHARD ; PIEPGRAS, DAVID G. / Carotid Endarterectomy in Patients With Contralateral Carotid Occlusion. In: Mayo Clinic Proceedings. 1993 ; Vol. 68, No. 4. pp. 337-342.
@article{d70abd6b79d34657a3ac77cd3172bbc4,
title = "Carotid Endarterectomy in Patients With Contralateral Carotid Occlusion",
abstract = "In this study, we assessed the results of carotid endarterectomy in 357 patients with a carotid stenosis and contralateral carotid occlusion. The overall major neurologic morbidity was 0.6{\%}, and the minor morbidity was 1.1{\%}. The causes of four perioperative deaths (1.1{\%}) were myocardial infarction in two patients, ruptured abdominal aortic aneurysm in one, and respiratory complications in one. Therefore, an excellent result was achieved in 97.2{\%} of patients. With occlusion of the carotid artery for the endarterectomy, 165 patients (46{\%}) had appreciable attenuation in intraoperative electro-encephalographic findings and a decrease in cerebral blood flow to approximately 10 ml/100 g of brain tissue per min that necessitated placement of a shunt. This high percentage of profound electroencephalographic and blood flow changes during carotid occlusion suggests that the potential for collateral blood flow in this group of patients is minimal. These results demonstrate that a carotid endarterectomy can be performed at low risk in patients with a contralateral carotid occlusion. We advocate annual noninvasive carotid testing for patients with asymptomatic carotid stenosis and contralateral carotid occlusion. If progression of the stenosis is evident, a prophylactic endarterectomy should be considered because these patients may have a higher risk for cerebral infarction than do patients with a unilateral asymptomatic stenosis.",
author = "MEYER, {FREDRIC B.} and FODE, {NICOLEE C.} and MARSH, {W. RICHARD} and PIEPGRAS, {DAVID G.}",
year = "1993",
doi = "10.1016/S0025-6196(12)60127-X",
language = "English (US)",
volume = "68",
pages = "337--342",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "4",

}

TY - JOUR

T1 - Carotid Endarterectomy in Patients With Contralateral Carotid Occlusion

AU - MEYER, FREDRIC B.

AU - FODE, NICOLEE C.

AU - MARSH, W. RICHARD

AU - PIEPGRAS, DAVID G.

PY - 1993

Y1 - 1993

N2 - In this study, we assessed the results of carotid endarterectomy in 357 patients with a carotid stenosis and contralateral carotid occlusion. The overall major neurologic morbidity was 0.6%, and the minor morbidity was 1.1%. The causes of four perioperative deaths (1.1%) were myocardial infarction in two patients, ruptured abdominal aortic aneurysm in one, and respiratory complications in one. Therefore, an excellent result was achieved in 97.2% of patients. With occlusion of the carotid artery for the endarterectomy, 165 patients (46%) had appreciable attenuation in intraoperative electro-encephalographic findings and a decrease in cerebral blood flow to approximately 10 ml/100 g of brain tissue per min that necessitated placement of a shunt. This high percentage of profound electroencephalographic and blood flow changes during carotid occlusion suggests that the potential for collateral blood flow in this group of patients is minimal. These results demonstrate that a carotid endarterectomy can be performed at low risk in patients with a contralateral carotid occlusion. We advocate annual noninvasive carotid testing for patients with asymptomatic carotid stenosis and contralateral carotid occlusion. If progression of the stenosis is evident, a prophylactic endarterectomy should be considered because these patients may have a higher risk for cerebral infarction than do patients with a unilateral asymptomatic stenosis.

AB - In this study, we assessed the results of carotid endarterectomy in 357 patients with a carotid stenosis and contralateral carotid occlusion. The overall major neurologic morbidity was 0.6%, and the minor morbidity was 1.1%. The causes of four perioperative deaths (1.1%) were myocardial infarction in two patients, ruptured abdominal aortic aneurysm in one, and respiratory complications in one. Therefore, an excellent result was achieved in 97.2% of patients. With occlusion of the carotid artery for the endarterectomy, 165 patients (46%) had appreciable attenuation in intraoperative electro-encephalographic findings and a decrease in cerebral blood flow to approximately 10 ml/100 g of brain tissue per min that necessitated placement of a shunt. This high percentage of profound electroencephalographic and blood flow changes during carotid occlusion suggests that the potential for collateral blood flow in this group of patients is minimal. These results demonstrate that a carotid endarterectomy can be performed at low risk in patients with a contralateral carotid occlusion. We advocate annual noninvasive carotid testing for patients with asymptomatic carotid stenosis and contralateral carotid occlusion. If progression of the stenosis is evident, a prophylactic endarterectomy should be considered because these patients may have a higher risk for cerebral infarction than do patients with a unilateral asymptomatic stenosis.

UR - http://www.scopus.com/inward/record.url?scp=0027513654&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027513654&partnerID=8YFLogxK

U2 - 10.1016/S0025-6196(12)60127-X

DO - 10.1016/S0025-6196(12)60127-X

M3 - Article

C2 - 8455391

AN - SCOPUS:0027513654

VL - 68

SP - 337

EP - 342

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 4

ER -