External Carotid Endarterectomy Followed by Superficial Temporal Artery to Middle Cerebral Artery Anastomosis for Internal Carotid Artery Occlusion with Advanced Ipsilateral External Carotid Stenosis

Objective: For patients with internal carotid artery occlusion with advanced narrowing of the ipsilateral external carotid artery (ECA), we performed preventive carotid endarterectomy (CEA) for the ECA stenosis before superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis for internal carotid artery occlusion. Methods: Between August 2002 and July 2005, we treated seven patients with such lesions, six men and one woman, ranging in age from 52 to 66 years (median, 60 yr). Before STA-MCA anastomosis, we performed preventive CEA for advanced ECA stenosis (>70%) to ensure sufficient blood flow to the STA. STA-MCA double anastomoses were performed more than 1 month after the CEA. Postoperative cerebrovascular complications and carotid restenosis were investigated. Results: All patients in the present series had an excellent postoperative course without cerebrovascular complications during either the CEA or STA-MCA anastomosis phase. Furthermore, no postoperative carotid restenosis occurred, and all STA-MCA anastomoses were patent during a mean follow-up period of 35.6 months. Conclusion: The present study suggests that surgical management by external CEA followed by STA-MCA anastomosis is safe and effective for patients with internal carotid artery occlusion and advanced stenosis of the ipsilateral ECA.