Endarterectomy of the Totally Occluded Carotid Artery for Stroke

CAROTID endarterectomy continues to play an increasingly important role in the definitive management of patients with cerebrovascular insufficiency syndromes when the obstructing lesions are located in the extracranial vasculature. If the atherosclerotic plaque is only partially occlusive and the distal internal carotid is patent on the arteriogram, restoration of cerebral blood flow by surgical reconstruction is almost uniformly successful. This is not the case, however, if the internal carotid is totally occluded.1A considerable difference of opinion exists in the literature regarding the advisability of operation on the totally occluded carotid. Some authors believe that exploration is not worthwhile,2,3but others are liberal in exploring both the acutely and chronically occluded internal carotid.4It is the purpose of this paper to record our experiences with the management of totally occluded carotid arteries based on an analysis of clinical results in patients subjected to endarterectomy over a ten-year