Five hundred twenty-six patients who underwent carotid endarterectomy were separated by reviewing those 81 (15%) patients with an occluded contralateral carotid artery and those 445 (85%) with nonocclusion. The population characteristics and surgical indications were similar between the occluded and nonoccluded groups. Ipsilateral plus contralateral perioperative stroke occurred during 11 of 445 operations (2.5%) in which the contralateral carotid was patent, and during which no patient was hemorrhagic. Those patients with contralateral artery occlusion had ipsilateral plus contralateral stroke in 4 of 81 cases (4.9%) (NS). Intracerebral hemorrhage was responsible for two of four strokes after carotid endarterectomy with contralateral occlusion (p=0.001). Restenosis to greater than 50% by duplex scanning was more rapid in the occluded group with primary closure (no patch) (p=0.025) and for men (p=0.025). Although perioperative safety is comparable, patients with contralateral carotid occlusion may have a greater risk of intracranial hemorrhage and a more rapid rate of restenosis in some subgroups.
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