Unilateral internal carotid arterial occlusion: Special considerations

Cases of patients with unilateral internal carotid arterial occlusion and contralateral internal carotid arterial stenosis are reviewed. Forty-two percent presented with a fixed neurological deficit. The deficit was referable to the side of occlusion in 92% and to the side of stenosis in 8%. Eleven percent had a neurological complication following carotid endarterectomy on the side of the stenotic lesion. The neurological complication was referable to the side of stenosis in 67% and to the side of occlusion in 33%. Patients have been followed for an average of 19 months and have not developed any additional TIA’s or strokes in the followup period. There may be a role for an extracranial-intracranial bypass (ECIC) on the occluded side prior to an endarterectomy on the stenotic side if a poor collateral situation exists. An ECIC should be done in patients who remain symptomatic following carotid endarterectomy on the stenotic side. These data do not support doing ECIC in asymptomatic patients with unilateral carotid arterial occlusion.