Benefit of external carotid endarterectomy in patients with advanced cerebrovascular disease.

The external carotid artery and its branches may serve as critical collateral pathways to the cerebral hemisphere when the internal carotid artery is occluded. In this setting, a stenotic lesion of the external carotid artery can result in hypoperfusion as well as lead to embolic phenomena via enlarged collaterals. This is a report of an experience with six external carotid endarterectomies in five patients from April 1983 to March 1986. All five of the patients had an internal carotid artery occlusion ipsilateral to a significant external carotid artery stenosis. Each patient had symptomatic cerebrovascular insufficiency with four of the five patients demonstrating clear cut symptoms, which lateralized to the side with external carotid stenosis and internal carotid occlusion. These symptoms included amaurosis fugax in four patients and transient extremity weakness in two patients. Four out of five patients were completely relieved of their symptoms after external carotid endarterectomy with follow up periods ranging from 6 months to 2 and one half years. There were no perioperative neurological deficits or complications. The duplex scan was useful in identifying possible candidates for this operation. Important technical details include use of an arterial shunt and closure of the internal carotid artery stump, which may be a source of further emboli. It is concluded that with appropriate patient selection, external carotid endarterectomy can be safely employed with gratifying results in patients with advanced cerebrovascular disease.