Stenosis of the carotid artery and thrombosis of the internal contralateral carotid. Analysis of surgical results in thirty patients.

Carotid thrombosis and stenosis of the contralateral axis is a hemodynamic situation which results in reduced blood supply to the brain, and consequently in risk of transitory or permanent ischemic episodes. In fact, 40% of patients are symptomatic for TIA or Little Stroke and 50% of them will develop a complete stroke. Of the 255 patients who underwent TEA, over a period of 5 years, only 30 presented the above mentioned bilateral feature. A continuous electroencephalographic recording (EEG) was intraoperatively carried on for cerebral monitoring, as well as mean residual arterial pressure (MRAP), and according to variations in these parameters Javid's shunt was used in 50% of cases. No death was recorded either during surgery or hospitalization, while 2 transitory post-operative neurological deficits (6.6%) in correspondence to the stenotic vessel, and a late permanent deficit contralateral to the stenosis were reported. We believe TEA of the stenotic carotid artery to be a rational choice considering the great incidence of strokes on the stenotic side (Grillo, 1975) and the greater benefit for patients with symptoms resulting from the occluded carotid (Riles, 1980), who account for 46.6% of our case histories. We are convinced that surgery is an absolute indication in this particular category of patients, even at the cost greater intraoperative risks, provided it is carried out by an experienced surgical team well aware of problems involved in intraoperative cerebral monitoring.