External carotid artery repair in cerebro-vascular insufficiency

From January 1985 to October 1992 ten patients were submitted to reconstruction of the external carotid artery (ECA). Nine were males and one female with age that ranged from 64 to 74 years, mean 68. All were symptomatic due to TIAs in seven and amaurosis fugax in four of this group, previous completed stroke plus TIAs in two and chronic low perfusion in one. Associated risk factors were smoking (8 pts: 80%), coronary disease (5 pts: 50%), hypertension (4 pts: 40%), diabetes (4 pts: 40%) and peripheral arterial obstructive disease (2 pts: 20%). All patients were submitted to non invasive (Doppler C. W., Echo-color Doppler) studies as well as angiography. All the patients had an occlusion of the internal carotid artery (ICA) unilateral and homolateral to external carotid stenosis in 8 and bilateral in 2; in addition three patients had a non haemodynamic stenosis of the contralateral ICA. One patient had an occlusion of the common carotid artery with collateral supply to the ECA; nine had severe stenosis of the ECA at the origin. In one case a homolateral vertebral stenosis was detected as well as a prevertebral contralateral subclavian stenosis in another one. Surgery was advised to correct amaurosis fugax, to increase external-internal collateral supply in order to avoid cerebral ischaemia and prior to contralateral ICA endarterectomy. All patients were operated upon under general anesthesia; an endarterectomy with a PTFE patch was performed in 9 cases, while in one a subclavian-ECA bypass was carried out using an autologous vein segment