We focused on complicated carotid lesions in 324 of our carotid endarterectomies (CEAs) to clarify controversies in carotid surgeries. Carotid lesions extented to the C2 level in over 20% of lesions. Bilateral stenotic lesions were operated in 22 cases without problems. Nine of 15 contralateral occlusion cases were supported with STA-MCA anastomosis indicated by the CBF. In near-occlusion cases, distal sites of lesions were detected by IVUS. Restenosis was observed in 9 cases. Only 1 restenotic case was symptomatic and 4 restenotic cases were reoperated with patch graft. Hemashield patch grafts were used in 18 cases and no restenotic changes were observed. Intracranial aneurysm was seen in 12 cases and 7 cases were clipped before CEA. Hyperperfusion syndrome was seen in 6 cases. Two cases showed intracerebral hemorrhage resulting in postoperative neurological deficits. Symptomatic occlusive coronary lesions were seen in 62 cases and surgical or intravascular treatment or both were performed in 30 cases.
Guidelines for CEA have been established by randomized controlled trails, but some cases have very complicated clinical features such as multiple lesions. For these cases, safer and more effective strategies should be established by collaborative studies.
