The potential benefits and indications for thromboendarterectomy for total occlusion of neck internal carotid artery causing acute neurologic deficits are still controversial. This report discusses the results of thromboendarterectomy for acute internal carotid artery occlusion in 7 patients, performed within 10 days after the first signs of neurological deterioration.
The patients were categorized in two groups depending on preoperative clinical symptoms and angiographic findings: 3 patients with mild stroke and good collateral flow and 4 patients with profound stroke and poor collateral flow. On preoperative CT scan, three patients including one of the minor stroke group already had a small infarction located in the border/terminal zone of middle cerebral artery. It was possible to restore the blood flow in 6 patients, but postoperative reocclusion occurred in one. The postoperative courses contrasted sharply in the two groups. In all three patients of mild stroke group, preoperative symptoms disappeared or improved after surgery. On the other hand, the results of 4 patients with profound stroke were extremely poor, including two postoperative deaths.
The results of this study and others reported in the literature indicate that careful case selection is mandatory in thromboendarterectomy for acute internal carotid artery occlusion. It is our present policy to operate positively on patients with progressing minor stroke and good collateral flow, but not to operate on patients with acute stroke and poor collateral flow.