Closely Sequential Carotid Endarterectomies in Patients with Bilateral Internal Carotid Artery Stenosis

Lee, Dong Joo; Kwon, Tae Won; Park, Ho Jong; Kwon, Sun Uck; Kang, Dong Wha; Jun, Heung Man; Cho, Yong Pil

Abstract

PURPOSE
The purpose of this study was to evaluate the efficacy and safety of closely sequential carotid endarterectomies (CEAs) for bilateral internal carotid artery stenosis.
METHODS
From September 1995 to December 2011, 953 CEAs were performed for internal carotid artery occlusive disease in Asan Medical Center. Seven hundreds eighty-five patients received unilateral CEA, and 84 patients received bilateral CEAs. Of the 84 patients with bilateral CEAs, 15 who underwent closely sequential CEAs with an intersurgical period of 7 days were included in this study. Retrospectively, surgical outcomes were evaluated and compared, regarding CEA-related parameters, and early and late mortality and morbidity rates between patients with closely sequential bilateral CEAs and unilateral CEA.
RESULTS
With this strategy, initial CEA was performed for the symptomatic side in symptomatic patients, or for the higher-grade carotid stenosis in asymptomatic patients. All 15 patients received contralateral CEA 7 days after initial CEA, and sufficient revascularization was obtained in all procedures. With a mean follow-up of 11.7 months, there were no perioperative neurological complications or strokes. During the follow-up period, early and late complications, except for transient cranial nerve injury, occurred without statistically significant difference between unilateral CEA and closely sequential bilateral CEAs.
CONCLUSION
Closely sequential bilateral CEAs showed excellent early and late clinical outcomes. Although the number of patients included in the study was few, our results demonstrated that closely sequential bilateral CEAs were safe and effective strategies for bilateral internal carotid artery stenosis. In addition, future clinical studies will be needed, with a greater number of patients.