Stenosis of one carotid artery with occlusion of the contralateral carotid

23 patients with unilateral internal carotid artery stenosis (greater than 70%) and contralateral internal carotid artery occlusion in the neck are reported. The symptoms are referable to the side of the occlusion in 13 cases (57%), to the side of stenosis in 7 cases (30%) and non-localizing in 3 cases (13%). All 23 patients had a carotid endarterectomy performed on the side of the stenotic lesion. There was no operative mortality. Late neurological symptomatology after surgery was referable to the side of stenosis in 13% and to the side of occlusion in 9%. The authors consider that, in cases of significant stenosis (greater than 70%) of an internal carotid artery with a contralateral occlusion, preference should always be given to end-arterectomy of the stenotic side, reserving extra-intracranial by-pass of the occluded side for patients who remain symptomatic after endarterectomy of the stenotic side.