Carotid endarterectomy contralateral to carotid artery occlusion: analysis from a randomized study |
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Authors: | Enzo Ballotta Giuseppe Da Giau Claudio Baracchini |
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Institution: | Vascular Surgery Section, Department of Medical and Surgical Sciences, University of Padua, School of Medicine, Policlinico Universitario, Via N. Giustiniani 2, 35128 Padua, Italy. enzo.ballotta@unipd.it |
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Abstract: | BACKGROUND AND AIMS: Many studies have reported the benefits of carotid endarterectomy (CEA) contralateral to an occluded internal carotid artery (ICA), with varying results. This study analyzed perioperative and late outcomes in a recent trial in which patients were randomized to carotid eversion endarterectomy (CEE) or traditional CEA with patching (CEAP). PATIENTS AND METHODS: In 336 primary CEAs (310 patients) 68 were contralateral to an occluded ICA (group I). The remaining 268 CEAs served as control group (group II). All patients underwent clinical follow-up and duplex ultrasonography at 1, 6, and 12 months and every year thereafter. Endpoints of the study were early and late neurological events, and deaths. RESULTS: Group I had a significantly higher incidence of perioperative electroencephalic changes and need for shunting. The perioperative stroke rate in group I was almost three times as high as in group II, but the difference was not significant. Similarly, the perioperative minor neurological event and death rates, as with the cumulative stroke-free and survival rates at 1, 3, and 5 years, were comparable in the two groups. CONCLUSIONS: CEA contralateral to an occluded ICA can be implemented with perioperative stroke and mortality rates and late stroke-free and survival rates comparable to CEA with no contralateral ICA occlusion. |
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