The natural history of total occlusion of the internal carotid artery.

We believe that total occlusion of the internal carotid artery is not a hallmark of end-stage atherosclerosis. We were unable to identify any factor that would place patients at particular high risk for the development of further problems. The status of the opposite carotid artery or a history of previous operation did not predict which patients would experience further neurologic episodes. New disease seems to be the most important factor influencing the incidence of new neurologic events. We therefore recommend that these patients be followed closely with serial noninvasive testing to identify such new disease. On the basis of these data we have adopted the policy that patients in whom new symptoms or severe new disease or both develop are considered candidates for operation.