Bilateral occlusive carotid disease: simultaneous or staged operation?

In a series of 231 carotid operations in 202 patients, 8 patients were operated on bilaterally by staged (group A), and 15 patients by simultaneous procedures (group B). Additionally 4 patients had a combined external carotid desobliteration plus extra-intracranial arterial bypass (group C), 3 of them in a simultaneous operation. Patients of the groups A and C had an uneventful recovery throughout. An additional group A patient, however, died during the staging interval due to an ischemic cerebral infarction at the not-yet-operated side. In group B one patient died after myocardial reinfarction and 4 showed other complications: diffuse hematoma of the neck, temporary palsy of the hypoglossal nerve, temporary left brainstem deficit and respiratory failure. Nevertheless, it is concluded that simultaneous bilateral carotid reconstruction offers specific benefits i.e. no risky interval, no second anesthesia and a reduced hospitalization period, and can therefore be recommended in selected cases.