Contralateral disease is not a determining factor for revascularization procedure in the carotid arterial diseases

Abstract

Objectives

Carotid arterial disease is one of the most important causes of stroke and the gold standard in its treatment is surgical endarterectomy. Different approaches have been reported regarding revascularization methods (stent/surgery) and surgical methods (with shunting/with-out shunting) in patients with contralateral carotid stenosis. In this study, revascularization methods and postoperative follow-up of patients with contralateral carotid arterial stenosis in our clinic were investigated.

Methods

Patients who underwent carotid endarterectomy in our clinic between 01.04.2019 and 30.04.2024 were retrospectively analyzed. Patients were divided into 4 groups according to contralateral carotid artery stenosis. On the contralateral side; patients with <50% stenosis constituted Group 1, patients with 50–69% stenosis constituted Group 2, patients with 70–99% stenosis constituted Group 3, and patients with total occlusion constituted Group 4. In all patients, the operation was performed with NIRS monitoring. The groups were compared in terms of postoperative neurological events and mortality.

Results

There were 248 patients, who had undergone carotid endarterectomy during the study period. There were 143 patients in Group 1, 47 patients in Group 2, 44 patients in Group 3, and 14 patients in Group 4. Demographics, preoperative findings and cross clamping times were similar between the groups. All of the operations except 2 with regional anesthesia were performed under general anesthesia. Shunting was required in 6 patients and arteriotomy was closed with patchplasty in 17 patients. In the comparison of postoperative events, there was no statistically significant difference between the groups in the terms of early-term minor (1.4%, 2.1%, 2.3%, and 0, respectively) and major (0.007%, 0, 2.3%, and 0, respectively) neurological events. There were 5 reoperations due to bleeding (3 in Group 1 and 2 in Group 2) 3 mortalities (1 in Group 1 and 2 in Group 3). There was no neurological event and mortality and 1 restenosis in Group 1 in the follow-up period.

Conclusion

In carotid artery stenosis, contralateral carotid artery stenosis is not a marker for determining the revascularization method. Performing the operation with standard precautions without deviating from routine practice has similar results to the surgical approach applied in unilateral stenosis. In these patients, the operation might be performed safely with precautions such as cerebral monitoring and not lowering blood pressure during the operation.