[Stenosis of the internal carotid artery with contralateral occlusion--primary vascular operation of externo-internal bypass?].

Among 2135 patients undergoing vascular surgery of the carotid artery, 144 revealed a stenosis of the internal carotid in combination with an occlusion on the contralateral side. Temporary inlying bypass shunts to support cerebral circulation during the endarterectomies were employed when technically feasible. The mortality among the in-patients amounted to 3.47%. Postoperative permanent neurologic deficits did not appear. During the follow-up period lasting between 1 month and 9 years 6.5% had further TIA's or strokes. Approximately 90% of the patients remained without neurologic symptoms. Neurosurgeons generally recommend a prophylactic external-internal bypass, prior to the removal of the stenosis of the internal carotid artery. According to our experience the primary objective should be the reconstruction of the stenosed artery, particularly since complications in primary external-internal bypassed occur in an average of 3-4%.