External carotid endarterectomy

Forty-nine external carotid revascularization procedures were performed in 36 patients. Indications included transient ischemic attacks, amaurosis fugax, and the procedure as a prelude to extracranial-to-intracranial bypass. Twenty patients had a preoperative neurologic defect. Twelve patients were classified as having bilateral and 24 as having unilateral carotid disease. Unilateral external carotid endarterectomy was performed in 29 patients, with the remaining patients undergoing procedures for additional occlusive lesions. Five patients had operation-related strokes (one death). Three of eight patients with bilateral disease and a preoperative neurologic defect had a stroke. Five additional patients had late neurologic events. Although technically easy, external carotid thromboendarterectomy should be advised with caution in patients with identifiable risk factors.