Neurologic sequelae with internal carotid artery occlusion

G. M. LaMuraglia, R. C. Darling, D. C. Brewster and W. M. Abbott

A retrospective review of the clinical course surrounding internal carotid artery occlusion (ICO) was undertaken in 97 patients with 106 instances of ICO. No neurologic symptoms could be attributed to more than half of the ICOs. Of the 52 symptomatic occlusions, 19 (37%) were associated with transient ischemic attacks and 33 (63%) with fixed strokes. Only 10% of all patients had permanent disabling neurologic sequelae. There was no correlation between development of neurologic symptoms and the side of the ICO, the presence or severity of contralateral carotid artery disease, or other risk factors. Women, however, were twice as likely as men to develop a fixed stroke with ICO. Seventy-six of these patients underwent reconstructive carotid surgery. Although there was a high rate of abnormal intraoperative findings with electroencephalographic monitoring (32 of 62 cases), with the use of intraoperative shunts there was no increase in the postoperative stroke complication rate (1.8%). These data suggest that the concern that ICO leads to serious fixed neurologic deficits may be overestimated, and that its presence does not adversely affect carefully performed contralateral carotid endarterectomy.