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

Robert L. Kistner, MD

Elna M. Masuda, MD

Department of Surgery, John A. Burns School of Medicine, University of Hawaii; Department of Vascular Surgery, Straub Clinic and Hospital, Honolulu

Howard P. Wong, MD

Straub Foundation, Honolulu, Hawaii

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.

Vascular and Endovascular Surgery, Vol. 32, No. 3, 221-232 (1998)
DOI: 10.1177/153857449803200303


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