The treatment of cerebral ischemia by external carotid artery revascularization
J. J. Schuler, D. P. Flanigan, J. R. DeBord, T. J. Ryan, J. J. Castronuovo and L. T. Lim
Thirteen patients with internal carotid artery occlusion and symptomatic
external carotid artery stenosis underwent external carotid artery
revascularization by means of endarterectomy (n = 10) or subclavian
artery--external carotid artery bypass (n = 3). All patients but one were
followed up, for five to 46 months (mean, 20 months). There were no
operative deaths or complications and no late strokes. One patient (7.7%)
required early extracranial-intracranial (EC-IC) bypass for failure of the
external carotid artery endarterectomy to relieve the initial symptoms. All
remaining patients were completely (n = 9) or partially (n = 2) relieved of
symptoms, and EC-IC bypass was not required. There were no criteria
identified by either oculopneumoplethysmography or angiography that could
reliably predict the need for subsequent EC-IC bypass. Ninety-two percent
of the patients were adequately treated with external carotid artery
revascularization alone, suggesting that subsequent EC-IC bypass is seldom
required in patients with ipsilateral internal carotid artery occlusion and
external carotid artery stenosis.
