Does multiple vessel disease of brain supplying arteries influence the operative procedure in carotid endarterectomy?

In a prospective evaluation 159 patients with carotid artery stenosis showed a multiple artery disease in 78 to 99 % depending on the grade of cerebral artery insufficiency. Contralateral occlusion process could be detected in 15.7 %, internal and common carotid artery occlusion in 16 patients (10 %). 1595 patients picked out of the literature have been analyzed in respect of the natural history which showed a risk to develop a stroke in 4.5 %/year. In further 1286 operated patients of other reports the morbidity and mortality rate ranged 4.5 % and the risk of further neurologic events after operation was 2.4 %/year. The use of an intraluminal shunt after thrombendarterectomy proved to be a good procedure to lower the morbidity and mortality rate without any intraoperative monitoring.