Outcome of the Contralateral Carotid Artery in Patients Having Undergone Ipsilateral Carotid Endarterectomy: Results of Selective Management

Purposes: To evaluate the natural history of the carotid artery in patients who have undergone endarterectomy of the opposite carotid artery, study its relation to new neuro-logic events by clinical follow-up and serial duplex scanning, review the literature for management guidelines at present, and evaluate the impact on these guidelines from recently published prospective, randomized trials. Methods: A retrospective study of 275 consecutive patients who underwent carotid endarterectomy (CEA) from December 1985 through December 1992. Results: Of 275 patients, 115 were excluded (lost to follow-up, preoperative contralateral carotid occlusion, perioperative death or stroke) leaving 160 patients as the final study group. Progression of contralateral stenosis from <50 % to 50-79 % occurred in 13/113 patients (11.5%), all asymptomatic; from 50-79 % to 80-99 % in 10/38 patients (26.3%), (two symptomatic-one transient ischemic attack [TIA] and one stroke-<50 % to 80-99 % in one patient who was asymptomatic); no patient progressed to total occlusion. All nine patients with an initial contralateral stenosis 80-99 % remained asymptomatic (continued on next page