Margriet Fokkema, Boudewijn Reichmann, Anne G. den Hartog, Catharina J. Klijn, Frans L. Moll, Gert-Jan de Borst
University Medical Center Utrecht, Utrecht, The Netherlands.
OBJECTIVES: Selective endarterectomy of an external carotid artery (ECA) stenosis is considered a therapeutic option for patients presenting with symptomatic internal carotid artery occlusion (ICA), to correct cerebral hypoperfusion or eliminate a source of emboli. Objective was to study the operative results and durability of selective ECA endarterectomy in patients presenting with cerebrovascular symptoms in association with ipsilateral ICA occlusion.
METHODS: Between September 2000 and August 2010, 27 consecutive patients with TIAs or minor ischemic stroke, with occlusion of the ICA and concomitant stenosis of the ipsilateral ECA underwent ECA endarterectomy. We assessed 1) Perioperative clinical outcome < 30 days; 2) Long-term clinical outcome; and 3) ECA patency in terms of freedom of Duplex Ultrasound-detected >50% stenosis.
RESULTS: Successful endarterectomy of the ECA was performed in 26 patients (96.3%). In one patient the ECA was found to be occluded during surgery. One day after surgery, one patient developed an ipsilateral disabling ischemic stroke (3.7%); no deaths occurred perioperatively. After two weeks, two patients (7.4%) had episodes of monocular blindness. Long-term follow-up was available at a median interval of 36 months (range –5-78) for 23 patients. One patient did not survive a major stroke (side unknown) at 18 months of follow-up. Another eight patient died from non-vascular cause (5) or of unknown reason (3). The ECA stayed free of >50% restenosis in 18 patients (78.3%). One patient (4.3%) developed symptomatic restenosis >50%, which was treated conservatively by tapering of antihypertensive medication.
CONCLUSIONS: Selective endarterectomy of the ECA in symptomatic patients with an ipsilateral occlusion of the ICA is a feasible procedure with acceptable perioperative risk and with a low rate of symptomatic restenosis.
AUTHOR DISCLOSURES: G. de Borst, Nothing to disclose; A. G. den Hartog, Nothing to disclose; M. Fokkema, Nothing to disclose; C. J. Klijn, Nothing to disclose; F. L. Moll, Nothing to disclose; B. Reichmann, Nothing to disclose.
Posted April 2012