Neurological outcomes after carotid endarterectomy in patients with contralateral carotid occlusion: One-year follow-up.

Abstract

Introduction: Neurological complications occur after CEA, independent of CCO. These neurological complications appear to occur more frequently in CEA patients with CCO. In our study, we aimed to share the perioperative and postoperative 1-year neurological results of CEA patients.

Methods: Patients who underwent CEA between January 2017 and January 2023 were retrospectively examined. Patients who underwent CEA with total occlusion of the contralateral internal carotid artery (ICA) were included in the study (42 patients). The patients were routinely checked on the 15th day, 6th month and 12th month after discharge, and the presence of symptoms (stroke, TIA) and carotid-related mortality were assessed.

Results: The average age of the patients was 69.18 ± 7.9 years. One patient experienced postoperative nerve damage, responded to anti-inflammatory treatment during follow-up and was discharged without sequelae. Weakness in the ipsilateral left arm developed in 1 patient. One patient who underwent postoperative revision as mentioned previously suffered stroke, and 1 patient had a history of TIA at the 6-month follow-up. During the 1-year follow-up, stroke developed in 1 patient, and diffuse infarction was observed in the ipsilateral median cerebral artery area. It is known that this patient is noncompliant with medical treatment. One patient died in the 10th postoperative month, but the direct relationship with mortality is unknown.

Conclusions: With respect to neurological risks in patients with CCO, CEA should always be performed by experienced surgeons. We believe that preoperative collateral evaluation during CEA in patients with CCO and the routine use of shunts during the procedure minimise the risk of cerebrovascular events.

Abbreviations: CEA: Carotid endarterectomy, CAD: Carotid artery disease, CCO: Contralateral carotid occlusion, CAS: Carotid artery stenting, ICA: internal carotid artery, TIA: Transient ischemic attack, NIRS: near-infrared spectroscopy.