[Indications for surgery of carotid artery stenosis with contralateral carotid occlusion].

In a retrospective study the course of 69 patients of the Surgery Department of the University of Heidelberg (66 men, 3 women, mean age 60 years) with carotid artery stenosis with contralateral carotid occlusion has been reported. 10% of the patients with carotid artery stenosis had a contralateral occlusion. Corresponding to the side of occlusion most patients had a preoperative neurological stage IV (55%, 19% stage II, 26% stage I) and corresponding to the side of stenosis most patients had a stage I (57%, 28% stage II, 4% stage III, 12% stage IV). In addition to the stenosis the occlusion had been operated on in 7 patients, in 5 of them the revascularisation was not possible. In 88% the arteriotomy could be closed using a venous patch and in 97% a intraluminal shunt was used. All operations were done under general anesthesia. The early lethality rate was 10%, in one patient a postoperative neurological deficit occurred. The late mortality rate was 21%, in 5% a new neurological deficit could be found (n = 57, mean follow-up: 3.0 years). In relation to the preoperative neurological stage corresponding to the side of stenosis the highest mortality rate was found in patients with stage IV. In a separate analysis of two periods (1962-1978 and 1979-1981) it can be demonstrated that the high early mortality rate is nearly entirely found in the first period with a low operative frequency. In the second period 1979-1981, 33 carotid endarterectomies in patients with contralateral occlusion were operated with a mortality rate of 3%.(ABSTRACT TRUNCATED AT 250 WORDS)