[Surgery of carotid stenosis combined with contralateral obstruction. Technic of carotid bypass].

Clamping of a carotid artery carries a considerable risk when the contralateral vessel is occluded. In a continuous series of 14 patients with carotid stenosis associated with contralateral occlusion, the possibility of substitute blood flow during clamping of the stentic vessel was evaluated by intra-operative measurement of carotid back pressure. In the 7 patients whose back pressure was higher than 40 mmHg, endarterectomy of the carotid bifurcation was performed in 6 cases and reimplantation for stenosing loop in 1 case. In the 7 patients whose carotid back pressure was lower than 40 mmHg, a carotid-carotid bypass was performed, the first anastomosis always being on the common carotid artery. No post-operative neurological accident was recorded. This technique seems to be preferable to a shunt, which is not always feasible, notably in cases with high bifurcation.