Trattamento chirurgico della stenosi carotidea controlaterale a trombosi della carotide interna. Contributo casistico e revisione della letteratura.

Carotid Stenosis with contralateral internal thrombosis represents a very high risk of incurring a stroke. To verify the exact role of carotid endoarterectomy in stroke prevention, we analyzed our series of 27 patients operated on between January 1982 and March 1991 and reviewed the literature over the ten last years. The preoperative status of the patients was asymptomatic in 38%; stroke was present in 26.9% and tia in 33%. The minimum grade of stenosis considered suitable for endoarterectomy was 60%. The operations were carried out under general anesthesia in 88%; 7 patients (25.9%) underwent concomitant myocardial revascularization and one had also mitral valve repair. The temporary shunt was used in 10 cases, wether in 3 patients, with simultaneous coronary artery bypass, the carotid endoarterectomy was performed under hypothermic CPB. There were no operative or hospital mortality. One patient was immediately reoperated on for early thrombosis, succesfully removed. Mean follow-up is of 34.1 mounths; during this period, free of cerebrovascular events, 6 patients died, but not for cerebrovascular events. On the basis of our results, compared with others of the literature, we conclude that mortality and morbility rates of carotid endoarterectomy, contralateral to a carotid thrombosis, are fairly comparable to those reported in patients without contralateral carotid occlusion.Moreover, the surgical approach to this complex cerebrovascular disease reduces the incidence of late stroke when compared with medical therapy only.