IS CONTRALATERAL OCCLUSION A RISK FACTOR FOR CAROTID ENDARTERECTOMY?

Aims. To determine whether there is any justification for considering patients with contralateral occlusion (CO) as a group at high risk for carotid endarterectomy (CE). To evaluate the effects of using shunts in these patients. We report the outcomes of the CE, comparing two groups of patients with and without CO. Patients and methods. Between January 1992 and December 2002, 328 CE were performed. A prospective study was conducted in which the risk factors, pre- operative symptoms and surgical technique were reviewed. Results. A total of 328 patients were submitted to surgery, 86.6% of whom were males. Of these, 12.5% had CO. The presence of CO in asymptomatic patients was significantly higher than in symptomatic subjects (p < 0.05). The rate of shunt use during surgery was higher in the group with CO (p < 0.001). Neurological morbidity in the overall series was 3.3%. No significant differences were observed in the percentage of post-operative strokes that were associated to the usage or failure to use shunts. Likewise, no significant differences were found with regard to the general post-operative morbidity and mortality rates between the group with CO and the group that did not have CO. Conclusions. The presence of CO does not increase the morbidity and mortality rates after carrying out a CE, which can be performed with acceptable results that are comparable to those obtained in patients without CO. The use of shunts in these patients is not associated to a decrease in the chances of suffering a stroke. The added risk of CO should not be considered to be an isolated risk factor in order to justify other therapeutic alternatives.