Proximal Common Carotid Artery Lesions: Endovascular and Open Repair

Abstract

Objectives

Management of proximal common carotid artery (pCCA) lesions is infrequently reported. We described open and endovascular treatment with regard to the neurological outcome and patency in patients suffering from atherosclerotic pCCA lesions.

Methods

Data were collected prospectively and analysed in a retrospective manner.

Results

From November 1991 to January 2010, 52 procedures, 24 surgical (11 bypasses, 12 transpositions and retrograde endarterectomy) and 28 endovascular (13 open transcervical and 15 transfemoral stent implantations) were performed (40.4% female, mean age 62.3 years, 65.4% left-sided). A total of 25 lesions (48.1%) were symptomatic (13 stenoses and 12 occlusions); 27 (51.9%) lesions were asymptomatic (22 stenoses and five occlusions). Two bypasses occluded within 30 days. Two early ipsilateral strokes were observed (3.8%). There was one perioperative death due to myocardial infarction after transcervical stent (1.9%). Mean follow-up was 61 months. In one transposition and two stent implantations, late redo interventions were performed. Fourteen of 48 patients died during follow-up.

Conclusion

pCCA repair for atherosclerotic lesions is associated with a substantial perioperative risk (combined stroke/death rate: 5.7%). Endovascular intervention is the preferred invasive treatment option in patients suffering from stenotic pCCA lesions. In cases of pCCA occlusion, open surgery is a valid alternative. Late survival in patients suffering from pCCA lesions is poor.