THE EFFECT OF CAROTID SIPHON STENOSIS ON STROKE RATE, DEATH, AND RELIEF OF SYMPTOMS FOLLOWING ELECTIVE CAROTID ENDARTERECTOMY

  • 1 January 1982
    • journal article
    • research article
    • Vol. 92  (6) , 1058-1067
Abstract
Carotid endarterectomy for carotid bifurcation disease may be contraindicated in the presence of carotid siphon lesions. This study was undertaken to assess any difference in stroke rate, mortality or relief of symptoms in patients with and without such tandem lesions following elective carotid endarterectomy. Bifurcation endarterectomies (91) were performed in 79 patients. The patients were divided into 2 groups. Group 1 (44 patients, 47 endarterectomies) had carotid bifurcation stenosis only; group 2 (35 patients, 44 endarterectomies) had siphon stenosis plus bifurcation stenosis. All patients in both groups who were symptomatic before operation were relieved of their symptoms. In group 1 there were no intraoperative or perioperative strokes, 4 late strokes (8.7%), 1 operative death (2.1%) and no late deaths. Group 2 patients had 2 intraoperative strokes (4.5%), 3 perioperative strokes (6.8%), 2 late strokes (5.1%), 4 operative deaths (9.1%) and 3 late deaths (7.5%). Eighteen of the 35 patients in group 2 had a greater degree of carotid siphon stenosis than bifurcation stenosis. In this subgroup, there was 1 operative stroke (5.6%), 1 perioperative stroke (5.6%), 1 late stroke (5.9%), 1 postoperative death (5.6%) and 1 late death (5.6%). None of these differences were statistically significant. Relief of symptoms was the same in patients with and without tandem carotid lesions, and there was no significantly increased risk of stroke or death following bifurcation endarterectomy in patients with tandem carotid lesions.