Nonendarterectomy Procedures of the Carotid Artery: A Vive-Year Review

Abstract

Although the efficacy of carotid endarterectomy has been well established, nonendarterectomy procedures of the carotid bifurcation have only sporadically been reported. Of 334 consecutive nontraumatic carotid procedures performed on 321 patients from July 1992 until May 1997, 306 (91.6%) were carotid endarterectomies, 14 (4.2%) were carotid-subclavian bypasses/transpositions, and 14 (4.2%) were nonendarterectomy procedures of the carotid artery. These latter 14 cases (nine females and five males; mean age, 63 years) were all symptomatic (neurological or painful mass) and included carotid kink/coil resection (n = 3; 0.9%), endarterectomy and vertebral transposition (n = 2; 0.6%), carotid aneurysm resection (n = 2; 0.6%), carotid body tumor resection (n = 2; 0.6%), carotid stump ligation/external endarterectomy (n = 1; 0.3%), infected/bleeding carotid patch removal with vein graft replacement (n = 1; 0.3%), saphenous vein graft replacement (n = 1; 0.3%), carotid dilatation for fibromuscular dysplasia (n = 1; 0.3%), and descending aorta to carotid bypass (n = 1; 0.3%). With 30 day follow-up complete for all 334 carotid operations, 10 perioperative strokes (2.9%) and five deaths (1.5%) occurred for a combined stroke/death rate of 3.3 per cent. Of the 14 nonendarterectomy carotid artery operations, there were no strokes or deaths; with mean follow-up of 13 months, 13 patients (92.9%) are asymptomatic, patent, and disease-free. Three severe transient cranial nerve (CN) neuropraxias (21.4%), one myocardial infarction (7.1%), and one late death (mesenteric ischemia at 2 months), however, occurred. Although no statistical differences in stroke, death, and stroke/death occurred between the endarterectomy versus the nonendarterectomy group, transient CN injury was more common in the nonendarterectomy group (21.4% versus 4.1%; P = 0.027). Although nonendarterectomy procedures of the carotid bifurcation are infrequently needed, they seem safe, effective, and indicated in selected patients, despite a higher incidence of transient CN injury.