Carotid Endarterectomy in the Presence of Contralateral Carotid Occlusion

Phillips, Martin R.; Johnson, Willard C.; Scott, R. Michael; Vollman, Rudolph W.; Levine, Harvey L.; Nabseth, Donald C.

doi:10.1001/archsurg.1979.01370350034003

Cited by 60 publications

(7 citation statements)

References 25 publications

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“…We found cerebral ischemia during clamping in 16% of patients with an ICA stenosis only and in 42% of patients with an ICA stenosis and a contralateral ICA occlusion. Although these proportions are in good accordance with a number of previous studies, 5,6,43,44 other studies found higher proportions, ranging from 25% to 38% in patients with an ICA stenosis only and from 59% to 71% in patients with an ICA stenosis and a contralateral ICA occlusion. 3,4,7 It is hard to explain these discrepancies, but there may have been differences in composition of study groups, methodology of EEG monitoring, or interpretation of EEG results.…”

Section: Rutgers Et Al Preoperative Mra Volume Flow In Cea Patientssupporting

confidence: 91%

Preoperative MRA Flow Quantification in CEA Patients

Rutgers

Blankensteijn

Grond

2000

Stroke

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Section: Rutgers Et Al Preoperative Mra Volume Flow In Cea Patientssupporting

confidence: 91%

Preoperative MRA Flow Quantification in CEA Patients

Rutgers

Blankensteijn

Grond

2000

Stroke

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“…2° '21 These results conflict markedly with more recent reports. Phillips et al 23 reported 37 patients who underwent CEA contralateral to an ICA occlusion, using shunts routinely, with no strokes and one Volume 16 Number 3 September 1992 Carotid endarterectomy with contralateral ocdusion 351 (2.7%) death. In a series of 53 patients, in which shunts were used selectively, Moore et al 24 reported two (3.8%) strokes and one (1.9%) death.…”

Section: Discussionmentioning

confidence: 99%

Does contralateral internal carotid artery occlusion increase the risk of carotid endarterectomy?

Perler

Burdick

Williams

1992

Journal of Vascular Surgery

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The results of every carotid endarterectomy performed contralateral to an internal carotid artery occlusion (n = 36) (group I) were compared with those performed contralateral to a patent internal carotid artery (n = 169) (group II) over the last 10 years. The patients in each group were evenly matched with respect to male gender (66% vs 69%); mean age (66.7 vs 65.9 years); and incidence of hypertension (55.6% vs 53.2%), diabetes (16.7% vs 20.1%), and hyperlipidemia (8.3% vs 11.8%). Patients in group I had a higher incidence of previous myocardial infarction (25% vs 11.8%, p less than 0.05) and exertional angina (55.6% vs 29.6%, p less than 0.01). Indications for carotid endarterectomy were equivalent, including stroke (19.4% vs 21.9%), transient ischemic attacks (36.1% vs 35.5%), amaurosis fugax (16.7% vs 11.8%), nonhemispheric symptoms (5.6% vs 8.3%), and asymptomatic stenoses (22.2% vs 22.5%), respectively. Perioperative strokes occurred in one (2.8%) patient in group I and seven (4.1%) patients in group II (NS). Among the patients in group II the incidence of perioperative stroke did not correlate directly with the degree of contralateral ICA stenosis: greater than 90% (4%); 70% to 90% (6.7%); 50% to 70% (8.7%); and less than 50% (2.8%). The operative mortality rate was 0% among patients in group I and 1.2% among patients in group II (NS). Cardiac complications occurred in two (5.6%) patients in group I and nine (5.3%) patients in group II (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Other risk factors associated with increased intra-?perative cerebral ischemia and postoperative stroke mclude contralateral internal carotid artery occlusion or high grade stenosis [27,28]. The authors' study reported use of an intra-arterial shunt in 53% of 135 recent carotid endarterectomies with an occluded contralateral internal carotid artery [29].…”

Section: Discussionmentioning

confidence: 93%

The Value and Limitations of Magnetic Resonance Angiography of the Circle of Willis in Patients Undergoing Carotid Endarterectomy

DePippo,

Ascher,

Scheinman

et al. 1999

Cardiovascular Surgery

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Magnetic resonance angiography is a useful technique to determine the patency of the circle of Willis when compared with conventional four-vessel angiography. The purpose of this study is to determine whether the integrity of the circle of Willis, assessed by magnetic resonance angiography, provides adequate collateral cerebral circulation during carotid endarterectomy and correlates with internal carotid artery back pressure. Over a recent 20-month period, 35 patients were studied preoperatively with magnetic resonance angiography of the carotid bifurcations of the circle of Willis and the vertebrobasilar system. All patients underwent standard carotid endarterectomy with intraoperative measurement of internal carotid artery back pressure. Patients with an internal carotid artery back pressure < 50 mmHg had an intraluminal shunt placed. Deficiencies in branches of the circle of Willis, the carotid bifurcation and the vertebrobasilar system determined by magnetic resonance angiography were correlated with internal carotid artery back pressure using Fisher's exact test. Only one patient had a completely intact circle of Willis. Eleven of 16 patients (69%) who had an internal carotid artery back pressure < 50 mmHg had an occluded A1 segment of the anterior cerebral artery combined with an occluded posterior communicating artery, whereas only five of 19 patients (26%) who had an internal carotid artery back pressure > 50 mmHg had similar findings ( P < 0.03). Severity of occlusive disease of the contralateral internal carotid artery and the basilar artery did not independently predict internal carotid artery back pressure. An occluded anterior branch of the circle of Willis in combination with an occluded posterior branch of the circle of Willis is associated with an internal carotid artery back pressure < 50 mmHg. Although magnetic resonance angiography of the circle of Willis may provide valuable anatomic information, it is not sufficiently accurate to predict the need for carotid shunting and therefore its use cannot be justified on a routine basis.

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Carotid Endarterectomy in the Presence of Contralateral Carotid Occlusion

Cited by 60 publications

References 25 publications

Preoperative MRA Flow Quantification in CEA Patients

Preoperative MRA Flow Quantification in CEA Patients

Does contralateral internal carotid artery occlusion increase the risk of carotid endarterectomy?

The Value and Limitations of Magnetic Resonance Angiography of the Circle of Willis in Patients Undergoing Carotid Endarterectomy

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