Natural History of Carotid Artery Occlusion Contralateral to Carotid Endarterectomy: Results from Randomized Trials

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Ali F. AbuRahma, M.D., Patrick A. Stone, M.D., Shadi Abu-Halimah, M.D., Christine A. Welch, M.S..
Robert C. Byrd Health Sciences Center of W. Va. Univ., Charleston, WV, USA.

 BACKGROUND:
The natural history of patients with carotid artery occlusion (CAO) is controversial. A few studies have concluded that patients with CAO carry a high risk of neurological events. None of the previously reported studies analyze the natural history of CAO contralateral to carotid endarterectomy (CEA), except for a small subset of patients from the ACAS and NASCET. This study analyzes the natural history of patients with CAO contralateral to CEA from two randomized CEA trials at our institution.
METHODS:
Out of 599 CEAs (544 patients) that were included in two randomized CEA trials, 63 patients had contralateral CAO. Strokes or TIAs were designated as ipsilateral if they arose from the CEA site and contralateral if they arose from the occluded contralateral carotid artery. A Kaplan Meier analysis was used to estimate the rate of freedom from contralateral stroke and contralateral stroke-free survival.
RESULTS:
There were 63 patients in this study with a mean follow-up of 58 months (range of 1-147 months). There was one perioperative ipsilateral stroke (1.6%) with no contralateral stroke. There were two late contralateral strokes (3.2%) and nine late contralateral TIAs (14.3%). There were also three (4.8%) late ipsilateral TIAs with no late ipsilateral strokes. There were a total of 14 late deaths. The rates of freedom from contralateral strokes and the contralateral stroke-free survival at one, three, five, and ten years were 98%, 96%, 96%, and 96%; and 90%, 87%, 80%, and 59%, respectively.
CONCLUSIONS:
The natural history of CAO contralateral to CEA is more benign than what was previously reported for patients with CAO without CEA. This may suggest a protective effect of the contralateral cerebral hemisphere from late strokes when CEA is done in these patients.

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