Simultaneous Bilateral Carotid Endarterectomy: A Revision of Concepts and Strategies

The results of 156 bilateral cases of carotid endarterectomy are reported: 71 patients had staged operations and 85 patients had simultaneous endarterectomies. The results in these two groups of bilateral cases were very similar. In each of the two groups no patient died and the major neurologic complications (stroke) were less than 2% in regard to patient risk, and therefore less than 1% in regard to procedure risk. Indications for and against bilateral carotid surgery as a simultaneous or a staged procedure are discussed. The parameters for selecting patients likely to undergo simultaneous surgery are indicated. The main parameter to consider is the probability for the patient to have a serious post-operative hyperperfu sion, especially if a cerebral ischemia coexists.