Management of carotid artery occlusion.

any authors have drawn attention to occlu- sive disease of the carotid arteries as a cause of cerebral ischemia.Although total carotid artery occlusion may be caused by different disease entities, by far the most frequent cause remains atherosclerosis.However, because of uncertainty about the pathophysiology of symptomatic internal carotid artery (ICA) occlusion, there has been controversy surrounding its proper management. Natural History of Carotid Artery OcclusionEarly studies 12 gave a good overall idea of the prognosis following carotid artery occlusion, but in many cases the information was incomplete.These studies were limited by 1) the inclusion of patients with moderate to severe neurological deficits whose prognosis for survival may differ from that of less severely affected individuals and in whom it may be difficult to detect new ischemic events in a vascular territory where a major stroke has already occurred, 2) no information on the exact localization of recurrent ischemic events during follow-up, and 3) the inclusion of patients treated with either anticoagulants or carotid surgery, both of which may influence morbidity and mortality.Recently, more complete data have become available on this condition. 3-7 In general, prospective studies of carotid artery occlusion suggest a higher stroke rate during follow-up than retrospective series, on the order of 5% or more per year. 3-5 This rate is similar to the one found in the subgroup of patients with ICA occlusion treated medically in the ExtracraniaHntracranial (EC-IC) Bypass Study. 8rospective analysis is a more sensitive investigative tool that permits the detection of minor strokes or reversible ischemic neurological deficits that may go undetected in a retrospective study, especially in those cases in which there is no permanent impact on the functional status of the patient.In our study 5 the exclusion of patients with a minor stroke not affecting functional status reduced the annual stroke rate from 5% to 3% ipsilateral to the occluded artery, which compares well with the rates found in retrospective series.Overall, the risk of stroke and vascular mortality in patients with ICA occlusion