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Outcome Analysis of Carotid Artery Occlusion

Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, jalexander{at}metrohealth.org

John Moawad, MD

Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio

Dennis Super, MD

Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio

The outcome of carotid artery occlusion was studied through the retrospective identification of 115 affected patients. The majority were white (77%) males (61%) with multiple atherogenic risk factors and suffering ipsilateral stroke (57%). Those patients presenting with stroke were not distinguished by demographic features, risk factors, lipid profile, medical regimen, or subsequent mortality when compared with those without. Overall, 36 patients (31%) required contralateral carotid endarterectomy (CEA), with one (2.8%) perioperative stroke, whereas 4 (3%) underwent ipsilateral external CEA without incident. With 81% follow-up (mean 3.9 years), the overall mortality of the group was 46%; the annualized risk of ipsilateral stroke was 1.6%. This study documents a significant risk of stroke and contralateral occlusive disease with ipsilateral carotid artery occlusion, which cannot be reliably predicted by clinical criteria. Duplex surveillance is valuable, but flow velocity measurements alone may be misleading. Surgical endarterectomy can be performed with an acceptable rate of perioperative stroke.

Key Words: carotid occlusion • outcomes • stroke • death • risk

Vascular and Endovascular Surgery, Vol. 41, No. 5, 409-416 (2007)
DOI: 10.1177/1538574407305095


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