Asymptomatic Carotid Lesions After Endarterectomy of Contralateral Carotid Artery

Schroeder, Torben V.; Helgstrand, U.; Egeblad, M; Engell, H. C.

doi:10.1001/archsurg.1987.01400190061012

Cited by 16 publications

(8 citation statements)

References 28 publications

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“…Our findings that the incidence of disease progression was significantly higher in patients with a higher degree of stenosis (P ϭ .016) and that progression from moderate to severe stenosis took significantly less time than progression from initially mild to moderate stenosis (P ϭ .033) are consistent with other reports. 9,[13][14][15] In the AbuRahma and colleagues' series 14 of 420 patients followed up for a mean 41 months after CEA with an average of 3 duplex US scans, contralateral ICA disease occurred statistically more frequently in patients with moderate than with mild ICA lesions (47% vs 36%; P ϭ .003), and the median time to progression was twice as fast for moderate than for mild stenoses (12 vs 24 months, respectively; P ϭ .035). Similarly, Raman et al 15 found an overall annual rate of disease progression in the contralateral ICA of 8.3% and an annual rate of progression to severe stenosis or occlusion of 4.4% in a cohort of 233 patients, 3 in 4 of whom had either no or only mild ICA lesions at baseline duplex US scan and were followed up for a mean 27 months after CEA, with an average of 3.7 duplex US scans.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Although many studies have clearly documented the progression of carotid plaque in unoperated asymptomatic patients, [5][6][7] the incidence of contralateral asymptomatic disease progression after ipsilateral CEA and the frequency with which such progression correlates with neurologic events have been examined in fewer studies and with mixed find-ings. [8][9][10][11][12][13][14][15][16] The variability of the resulting picture can be attributed mainly to the definition of disease progression, the methods used to report events, and the duration of the follow-up. Whereas some investigators define progression as any change in a carotid lesion to a higher degree of stenosis, [8][9][10] others call it progression only when the stenosis reaches a 50% to 79% (or more) narrowing of the lumen.…”

mentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15][16] The variability of the resulting picture can be attributed mainly to the definition of disease progression, the methods used to report events, and the duration of the follow-up. Whereas some investigators define progression as any change in a carotid lesion to a higher degree of stenosis, [8][9][10] others call it progression only when the stenosis reaches a 50% to 79% (or more) narrowing of the lumen. 11,12 The concept of progression used in various studies consequently seems to be somewhat contrived.…”

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confidence: 99%

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Progression of atherosclerosis in asymptomatic carotid arteries after contralateral endarterectomy: A 10-year prospective study

Ballotta

Giau

Meneghetti

et al. 2007

Journal of Vascular Surgery

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This prospective analysis has shown that disease progression in contralateral asymptomatic ICAs after CEA is relatively common in patients with a diseased ICA at the baseline and strongly supports duplex US surveillance, approximately every 6 months, in patients with more than mild disease. A baseline lesion is significantly predictive of progression to severe stenosis, and progression from moderate to severe stenosis is strongly associated with neurologic clinical events. No demographic or clinical factor proved useful in identifying patients likely to experience disease progression.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Progression of atherosclerosis in asymptomatic carotid arteries after contralateral endarterectomy: A 10-year prospective study

Ballotta

Giau

Meneghetti

et al. 2007

Journal of Vascular Surgery

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“…The issue, whether an initially asymptomatic concomitant contralateral stenosis or plaque should be operated upon or not is still controversial l~ 29,36 The above considerations suggest that a method to identify those plaques with embolic potential would have significant impact on the indication for endarterectomy. These events could probably have been prevented by initialy staged bilateral carotid endarterctomy.…”

Section: Discussionmentioning

confidence: 99%

Results of microsurgical carotid endarterectomy

et al. 1989

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100 consecutive carotid endarterectomies in a total of 93 patients were performed using the operative microscope. Cerebral perfusion and activity were monitored with simultaneous transcranial Doppler (TCD) and EEG. Thiopentone for cerebral protection was given prior to carotid clamping in 11 cases when an insufficient collateral circulation was suspected on the basis of the pre-operative TCD or angiography and if temporary intraluminal shunting was to be avoided because of a high bifurcation, long stenosis or associated carotid artery kinking. A temporary intraluminal shunt was inserted electively if the mean middle cerebral artery flow velocity fell after cross-clamping below 30-40%. Direct closure of the arteriotomy was preferred over a patch graft, which was performed only in cases with concomitant stricture of the arterial wall. No peri-operative strokes occurred in the present series. Two patients died due to medical complications in the post-operative period. During the mean follow-up of 15 months, 1 patient suffered a lethal stroke ipsilateral to the treated carotid artery and another patient had a minor contralateral stroke. Two patients died of unrelated causes during follow-up. Two patients suffered a single reversible neurologic deficit corresponding to the treated carotid territory. Four other patients had a single contralateral hemispheric or retinal reversible ischaemic attack during follow-up.

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“…If we accept NASCET and ACAS as hard data being prospective, randomized trials, what other softer data do we have to support indication for CEA on the contralateral side? Concerning risk factors, hypertension seems to amplify the indication for CEA.21, 22 The character of the plaque seems to gain more importance. If the plaque on the operated-on side is highly degenerated and ulcerated, the indication for contralateral CEA is enhanced.…”

Section: New Guidelines For Managementmentioning

confidence: 99%

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

Eklöf¹,

Kistner²,

Masuda

et al. 1998

Vascular Surgery

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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 (Abstract continued) 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.

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Asymptomatic Carotid Lesions After Endarterectomy of Contralateral Carotid Artery

Cited by 16 publications

References 28 publications

Progression of atherosclerosis in asymptomatic carotid arteries after contralateral endarterectomy: A 10-year prospective study

Progression of atherosclerosis in asymptomatic carotid arteries after contralateral endarterectomy: A 10-year prospective study

Results of microsurgical carotid endarterectomy

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

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