Operative treatment was applied in 139 patients with hemodynamically significant bilateral stenosis of the carotid arteries due to atherosclerosis. Three groups could be distinguished: group I--stenosis greater than 75% on one side and between 50 and 75% on the other side; group II--stenosis greater than 75% on both sides; group III--obstruction on one side and stenosis greater than 50% on the other side. The risk of clamping did not appear abnormally high, while the peroperative neurologic risk was slightly enhanced due to the possibility of accidents in the region which lies contralateral to that of the operated side, or in the region of the brain stem. The risk in the group III patients did not appear to be increased. Immediate and secondary neurologic prognosis is mainly a function of the presence of multiple peculiar lesions, and also of the presence or absence of parenchymatous ischemic lesions. Preventive surgery on narrowed, stenotic, progressive lesions, detected by ultrasound imaging systematically repeated every 6 months, diminishes the incidence of onset of neurologic complications.
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