The results of 156 bilateral cases of carotid endarterectomy are reported: 71 patients had staged operations and 85 patients had simultaneous endarterectomies.
The results in these two groups of bilateral cases were very similar. In each of the two groups no patient died and the major neurologic complications (stroke) were less than 2% in regard to patient risk, and therefore less than 1% in regard to procedure risk.
Indications for and against bilateral carotid surgery as a simultaneous or a staged procedure are discussed. The parameters for selecting patients likely to undergo simultaneous surgery are indicated. The main parameter to consider is the probability for the patient to have a serious post-operative hyperperfu sion, especially if a cerebral ischemia coexists.
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References
1.
De Weese JA, Rob CG, Satran R., et al: Results of carotid endarterectomy for transient ischemic attacks five years later. Ann Surg178:258-264, 1973.
2.
Podore PC, De Weese JA, May AG, et al: Asymptomatic contralateral carotid artery stenosis: A five-year follow-up study following carotid endarterectomy. Surgery88:748-752, 1980.
3.
Riles TS, Imparato AM, Mintzer R., et al: Comparison of results of bilateral and unilateral carotid endarterectomy five years after surgery. Surgery91:258-262, 1982.
4.
Hennereci M. , Hulsbomer HB, Heftor H., et al: Natural history of asymptomatic extracranial arterial disease. Results of a long-term prospective study. Brain110:777-791, 1987.
5.
Javid H., Ostermiller WE, Hengesh JW, et al: Natural history of carotid bifurcation atheromata. Surgery67:80-86, 1970.
6.
Johnson JM, Kennelly MM, Decesare D., et al: Natural history of asymptomatic carotid plaque. Arch Surg120:1010-1012, 1985.
7.
Taylor LM Jr , Loboa R. , Porter JM: The clinical course of carotid bifurcation stenosis as determined by duplex scanning. J Vasc Surg8:255-261, 1988.
8.
Ott DA, Cooley DA, Chapa L., et al: Carotid endarterectomy without temporary intraluminal shunt . Ann Surg191:708-714, 1980.
9.
Thompson JE, Austin DJ, Don Patman R: Carotid endarterectomy for cerebrovascular insufficiency: Long-term results in 592 patients followed up to thirteen years. Ann Surg72:663-679, 1970.
10.
Leahy AL, McCollum PT, Feeley TM, et al: Duplex ultrasonography and selection of patients for carotid endarterectomy: Plaque morphology or luminal narrowing ?J Vasc Surg8:558-562, 1988.
11.
Pizzetti F.: Considerazioni critiche sull'uso degli anticoagulanti nelle insufficenze cerebrovascolari da lesioni arteriose carotidee. Arch Chir Torac Cardiovasc10:339-344, 1988.
12.
Pizzetti F.: E' veramente corretto l'uso degli anticoagulanti nella patologia ateromasica carotidea? Rec Progr Med79:361-364, 1988.
13.
Cooley DA: Carotid endarterectomy from first recorded case to present. Texas Heart Inst J15:139-141, 1988.
14.
Pomposelli FK , Lamparello PJ, Riles TS, et al: Intracranial hemorrhage after carotid endarterectomy. J Vasc Surg7:248-255, 1988.
15.
Prioleau WH Jr, Voegele LD, Hairston P.: The lucid interval in stroke following carotid endarterectomy. Am Surg51:114-115, 1985.
16.
Steed DL, Peitzman AB, Grundy BL, et al: Causes of stroke in carotid endarterectomy. Surgery92:634-641, 1982.
17.
Sundt TM Jr , Sharbrough FW, Piepgras DG, et al: Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy , Mayo Clin Proc56:533-543, 1981.
Thompson JE: Bilateral carotid stenosis with nonlateralizing symptoms. In: Common Problems in Vascular Surgery, ed. by Brewster DC.Chicago: Year Book Medical Publishers, 1989.pp 3, 35-38.
Caplan LR, Stilman J., Ojeman R., et al: Intracerebral hemorrhage following carotid endarterectomy: A hypertensive complication. Stroke9:457-460, 1978.
22.
Kannel WB, Wolf PA, Verter J., et al: Epidemiologic assessment of the role of blood pressure in stroke: The Framinghan Study. JAMA213:1143-1152, 1970.
23.
Wade JG, Larson CP Jr, Hickey RF, et al: Effect of carotid endarterectomy on carotid chemoreceptor and baroreceptor function in man. N Engl J Med282:823-829, 1970.
