During a 3-year period, 51 patients (38 men and 13 women, mean age 60.3 years) were diagnosed as having bilateral occlusive carotid disease by angiography. Two patients had bilateral carotid occlusion and 12 patients had unilateral carotid occlusion and contralatral stenotic carotid lesions. Another 37 patients had various degrees of stenotic lesions on bilateral carotid arteries. Presenting symptoms included transient ischemic attacks (TIA) in 7 patients, minor stokes in 34, major strokes in 7 and nonfocal symptoms in 3.
In this series, 11 patients were operated on bilaterally and 19 patients were operated on unilaterally. So totally 41 operations were canducted in 30 patients. Bilateral STA-MCA anastomoses, bilateral endarterectomies and a combined STA-MCA anastomosis and endarterectomy were performed in 6, 3 and 2 patients respectively. All bilateral operations were staged. Unilateral STA-MCA anastomosis, unilateral endarterectomy and external decompression were performed in 11, 7 and 1 patients respectively. There were one perioperative stroke (3.4%) and two deaths (6.7%).
Forty-nine patients were followed up 10 to 42 months. Three of 28 pateints (11.1%) treated by operation(s) suffered recurrent stroke during the follow-up period. Two developed TIA and/or minor stroke referable to the side that underwent carotid endarterectomy. Another one developed minor stroke referable to the side of STA-MCA anasatomosis for carotid occlusion. On the contrary, 5 of 20 patients treated conservatively suffered strokes during the follow-up period.
