Occlusion of the Carotid Artery: Prognosis (Natural History) and the Possibilities of Surgical Revascularization

Abstract

A retrospective study was made of a group of 44 patients with arteriosclerotic occlusion of the internal carotid artery trying to identify a group that might benefit from extracranial-intracranial arterial bypass. Eight of the 44 patients died of cerebral infarction. Seven of these deaths were due to the cerebral infarction that prompted the arteriogram and the only fatal infarct during the period of follow-up occurred in the opposite cerebral hemisphere. Four nonfatal strokes occurred during the follow-up period, and these also were in the cerebral hemisphere contralateral to the carotid occlusion. We conclude that the role of extracranial-intracranial arterial bypass is limited to the occasional patient who has recurrent symptoms due to vascular insufficiency in the cerebral hemisphere distal to an occluded carotid or middle cerebral artery. The main role of surgery appears to lie in the opening of the occluded carotid artery in selected patients with acute stroke and in the prophylactic repair of contralateral carotid stenosis.