A reassessment of carotid endarterectomy in the face of contralateral carotid occlusion: surgical results in symptomatic and asymptomatic XXXX .

@entity1 @entity101 @entity2998 @entity432 @entity543
OBJECTIVE: Total occlusion of the contralateral internal carotid artery has often been considered to be a predictor of poor outcome after carotid endarterectomy (CEA) of @entity543 . Data from both the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic @entity2998 Study have suggested this to be true. However, each of these trials had relatively few @entity1 with @entity432 in the surgical arms of the studies. Recently, advocates of carotid angioplasty and stenting have suggested that this technique may be preferable in @entity1 with a @entity432 because of the perceived poor outcome with surgery. The purpose of this study was to review a large series of CEAs performed in @entity1 with @entity432 to see whether results differed from @entity1 with patent contralateral arteries and to determine whether the presence of preoperative symptoms was an important factor in outcome in these cases. @entity1 AND METHODS: A review was conducted of a prospectively compiled database of all primary CEAs performed at our institution from 1985 to 1999. Surgery was performed on 2420 @entity1 , of whom 338 (14.0%) had @entity432 . RESULTS: @entity1 with @entity432 were more likely to be symptomatic (65.7% versus 60.1%; P =.1), male (70.9% versus 58%; P <.001), and @entity101 (63.9% versus 58.4%; P =.07) with a positive smoking history (42.6% versus 31.4%; P <.001) than @entity1 with patent contralateral carotid artery. No significant difference was seen in the rates of perioperative neurologic events between @entity1 with @entity432 (3.0%) and those without (2.1%; P =.34). Among the total of 913 asymptomatic @entity1 , of whom 115 had @entity432 , no difference was seen in the rate of perioperative neurologic events (1.8% for @entity432 cases; 1.9% for cases without @entity432 ). Among the total of 1507 symptomatic @entity1 , of whom 223 had @entity432 , no significant difference was seen in the rate of perioperative neurologic events (3.7% for @entity432 cases; 2.2% for cases without @entity432 ; P =.2). CONCLUSION: The presence of @entity432 does not appear to increase the perioperative risk of CEA. Although the risk of CEA in symptomatic @entity1 with @entity432 may be slightly increased, this must be weighed against the risk with medical treatment alone. CEA can be performed safely in @entity1 with @entity432 , which should not necessarily be considered a high-risk condition for surgery in favor of angioplasty and stenting.
