The influence of carotid siphon stenosis on short- and long-term outcome after carotid endarterectomy

Abstract

Purpose: This study was designed to determine whether the presence of ipsilateral carotid siphon stenosis influenced the risk of early and late stroke and death after carotid endarterectomy (CEA).

Methods: The outcomes of patients with moderate (20% to 49%), severe (> 50%), and no siphon stenosis were compared over a 16-year period from April 1976 to February 1992. Complete angiographic data were available in 393 carotid arteries.

Results: Siphon stenosis was found ipsilateral to the CEA in 84 (21.4%) of the arteries. Most lesions were in the 20% to 49% diameter-reducing range (77.4%), with the remainder in the greater than 50% range (22.6%). There were no occlusions. The perioperative mortality rate was nearly identical for the groups with and without siphon stenosis, 0.0% versus 0.6%, respectively (p = 0.99). Perioperative stroke morbidity rates (no stenosis, 2.3%; moderate stenosis, 3.1%; > 50% stenosis, 5.3%) were acceptable and were not statistically different (p > 0.38). Late ipsilateral stroke-free rates were similar in the groups with and without siphon stenosis. The 5- and 7-year stroke-free incidences were 88.5% and 83.4% versus 94.9% and 94.9%, respectively (p > 0.20) for the two groups. Long-term ipsilateral stroke-free rates were not significantly different in the subgroups with moderate (20% to 49%) and hemodynamically significant (> 50%) siphon stenosis. The 3- and 5-year ipsilateral stroke-free rates were 96.7% and 87.9% versus 94.6% and 94.6%, respectively (p = 0.69). Late death was more common in the group with siphon stenosis than it was in the group without siphon stenosis, 23.8% versus 12.5% (p = 0.02). Heart disease was responsible for most late deaths, 47% in both groups. Late stroke-related deaths were infrequent: 1.3% in patients with and 0.0% in patients without siphon stenosis.

Conclusions: Although carotid siphon stenosis seemed to be associated with a higher risk of late death, it did not alter the short- and long-term stroke morbidity rates after carotid endarterectomy significantly. We conclude that the presence of carotid siphon stenosis should not influence the decision to perform carotid endarterectomy in patients with the appropriate indications.