Carotid stenosis plus occlusion: endarterectomy or bypass?

In 15 patients with unilateral internal carotid artery occlusion and contralateral internal carotid artery stenosis of pressure significance (75% cross-sectional area or greater), the ocular pneumoplethysmograph (OPG-Gee) has documented bilateral improvement in the ophthalmic systolic pressure in 12/15 patients who underwent endarterectomy of the stenosed carotid artery as the sole operative procedure. External carotid to internal carotid shunt on the side of the internal carotid occlusion need be entertained only in those patients who remain symptomatic on the side of the internal carotid occlusion after contralateral stenosis endarterectomy.