Endarterectomy of the Totally & Subtotally Occluded Carotid Artery Facilitates the Surgery of the Stenosed Contralateral Side
Murat Ugurlucan *
Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey and Duzce Ataturk State Hospital, Turkey
Muslum Ercument Filik
Duzce Ataturk State Hospital, Turkey
Ertugrul Zencirci
Duzce Ataturk State Hospital, Turkey
Gamze Babur Guler
Duzce Ataturk State Hospital, Turkey
Ekrem Guler
Duzce Ataturk State Hospital, Turkey
Metin Onur Beyaz
Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Didem Melis Oztas
Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Omer Ali Sayin
Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Gabriele Piffaretti
Department of Surgery and Morphological Sciences, Vascular Surgery, University of Insubria, School of Medicine, Circolo University Hospital, Turkey
Fatma Nihan Turhan Caglar
Cardiology Clinic, Bakirkoy Sadi Konuk Hospital, Turkey
Mehmet Buget
Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Ufuk Alpagut
Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Enver Dayioglu
Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
*Author to whom correspondence should be addressed.
Abstract
Purpose: Patients with one side total/subtotal occlusion and contralateral side critical stenosis are high risk candidates for carotid interventions for the stenosed carotid side. We present our experiences with carotid endarterectomy of the stenosed side after revascularization of the occluded side.
Methods: Between March 2010 and September 2013, 85 carotid endarterectomies were performed in seventy-four patients. Among the patients, 6 had one side total/subtotal occlusion and contralateral side ³ 70% carotid stenosis. Patients received revascularization for the occluded side first followed by of the endarterectomy of the contralateral stenosed part.
Results: Four patients had cerebrovascular symptoms ipsilateral to the occluded side. Operations were performed with local anesthesia. Endarterectomy priority was given to the occluded side which was followed by the endarterectomy of the contralateral side after 17.2±4.6 days. No neurologic deficit occured during the surgeries and shunt was not required. Mortality did not occur and patients are followed a mean of 18.4±6.3 months event free.
Conclusion: Endarterectomy of the stenosed carotid artery contralateral to the totally/subtotally occluded side is challenging and carries high risk. The treatment of the occluded side first facilitates the endarterectomy of the contralateral carotid stenosis.
Keywords: Carotid artery disease, endarterectomy, chronic total occlusion