A 20-year Follow-up of Internal Carotid Artery Endarterectomy with Bifurcation Advancement[1]

Background: Carotid artery disease is a frequent cause of transient ischemic attack and of cerebral infarction. For two last decades, we have been performing endarterectomy of the internal carotid artery with bifurcation advancement. Methods: From January 1977 until December 1997, all records of patients who underwent internal carotid artery endarterectomy with bifurcation advancement were reviewed. Data were collected from patients charts and by a questionaire. 160 patients (80.6 % men, 19.4 % women, average lifetime 65.1 year) underwent a total of 181 endarterectomies with bifurcation advancement. Results: The 30-day mortality was 1.9 % and the postoperative stroke plus death rate 3.1 %. The incidence of reoperations was 0.6 % with an average follow up of 64 months. In one patient (0.6 %), a significant restenosis of the repaired carotid artery was observed. The 1, 5 and 10 years neurological death free survival (including early mortality) was 99.3 %, 97.2 % and 92.5 % and the overall survival (including early mortality) was 96.3 %, 78.9 % and 59.3 % (Kaplan-Meier). Conclusions: The technique of the internal carotid artery endarterectomy by bifurcation advancement is a safe and reliable method for improvement of cerebral blood supply. Or foreign material or autologous vein can thus be avoided. This method offers excellent long term patency and has a notable lack of late restenosis.

Carotid endarterectomy - Bifurcation advancement

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1 This paper has been presented at the 28th annual meeting (24. - 28. Feb. 1999) of The German Society of Thoracic and Cardiovascular Surgery in Dresden (J Thorac Cardiov Surg 1999; 47 Supplement: 35)