Surgical and nonsurgical treatment of total carotid artery occlusion

The natural history of totally occluded internal and common carotid arteries was studied in 102 patients (109 arteries) with a 97 percent follow-up (mean 39.7 months.) Symptomatic occlusions occurred in 72.6 percent of the patients, the reconstructed group (46 patients) having a greater number of symptomatic vessels than the nonreconstructed group (63 patients) (p less than 0.05). Contralateral disease was encountered in 46 percent. Initial mortality was 5 percent. Twenty patients (19.6 percent) were dead at the time of follow-up. Half of these deaths were from strokes and three fourths from atherosclerotic causes. Persisting neurologic symptoms were present in 14 percent of the patients and new events occurred in 5 percent. Fifteen percent of initially asymptomatic vessels were symptomatic at last follow-up. Twenty-one percent of the symptomatic occluded vessels were symptomatic on follow-up, 16 percent being in the reconstructed group and 26 percent in the nonreconstructed group.