Risk of Stroke for Carotid Endarterectomy Patients with Contralateral Carotid Occlusion

The role of a contralateral carotid occlusion in the appearance of neurological complications after carotid endarterectomy (CEA) operations is a matter of some debate. In the North American Symptomatic Carotid Endarterectomy Trial, the risk of perioperative stroke was found to be higher in patients with a contralateral carotid occlusion. In a literature survey in 2004, however, a significantly increased risk of perioperative stroke was found in only one out of 17 studies on contralateral carotid occlusion patients. We therefore examined the frequency of stroke in patients with contralateral carotid occlusion at our own institution and performed a meta-analysis based on 19 representative studies, including the data from our own institution. Out of 1,960 CEAs at the authors' institute, a significantly higher frequency of 5.6% compared to 2.1% (p = 0.012) for perioperative stroke risk was seen in patients with contralateral carotid occlusion compared to those without. The meta-analysis, based on 19 studies, also showed in 13,438 CEA operations a significantly higher perioperative stroke rate of 3.7% compared to 2.4% (p = 0.002) in the presence of a contralateral carotid occlusion. Nevertheless, due to the extremely poor outcomes of medically treated symptomatic patients, a surgical or endovascular procedure should be sought for these patients. Since the superiority of angioplasty/stent procedures has not yet been verified compared to surgical procedures in these patients, special indication for an endovascular procedure should also be taken into consideration.