Related Experiment Video
Updated: Jan 26, 2026
Modeling Stroke in Mice: Transient Middle Cerebral Artery Occlusion via the External Carotid Artery
Published on: May 24, 2021
Contralateral Occlusion and Concomitant Procedures Drive Risk of Non-ipsilateral Stroke After Carotid Endarterectomy
W Darrin Clouse1, Laura T Boitano1, Emel A Ergul1
1Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Non-ipsilateral stroke after carotid endarterectomy (CEA) is uncommon. Key risk factors include operative urgency, symptomatic disease, and contralateral occlusion, but long-term survival is similar to ipsilateral strokes.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Medicine
Background:
- Stroke following carotid endarterectomy (CEA) is a known complication.
- Factors contributing to non-ipsilateral stroke risk after CEA require further elucidation.
Purpose of the Study:
- To identify predictors of 30-day non-ipsilateral stroke after CEA.
- To evaluate long-term survival based on stroke laterality post-CEA.
Main Methods:
- Analysis of 80,230 CEA procedures from the Vascular Quality Initiative (VQI) database (2003-2017).
- Multivariable logistic regression to identify stroke risk factors.
- Kaplan-Meier analysis for long-term survival assessment.
Main Results:
- Non-ipsilateral stroke occurred in 0.6% of patients.
- Independent predictors included operative urgency, symptomatic disease, contralateral occlusion, shunt use, and combined procedures.
- Protective factors included dextran use and anti-angiotensin therapy.
- 30-day mortality was lower for non-ipsilateral strokes (6.1%) compared to ipsilateral strokes (10.3%).
- Five-year survival rates were similar for non-ipsilateral (73%) and ipsilateral strokes (76%), but worse than no stroke (88%).
Conclusions:
- Non-ipsilateral stroke post-CEA is rare, driven by systemic disease burden and procedural complexity.
- Contralateral carotid occlusion is an independent risk factor for non-ipsilateral stroke.
- Stroke after CEA, regardless of location, similarly impacts long-term survival.
Objectives:
Stroke after carotid endarterectomy (CEA) has been assessed widely. However, factors enhancing non-ipsilateral stroke risk are poorly defined. The aim of this study was to identify drivers of 30 day non-ipsilateral stroke after CEA in the Vascular Quality Initiative (VQI) and assess long-term survival based on laterality of post-operative stroke.
Methods:
The VQI was queried between April 1, 2003, and March 31, 2017, for all CEA. Bilateral carotid procedures within 30 days were excluded. Thirty day non-ipsilateral strokes were identified. Factors were examined to discriminate between patients with and without non-ipsilateral stroke. Univariable analysis followed by multivariable logistic regression was performed. Kaplan-Meier and log rank methods were used to estimate and compare survival.
Results:
During this 14 year period, 80,230 CEA in 74,928 patients met the criteria. The average age was 70.3 ± 9.3 years. Most were male (48,506; 60%), Caucasian (73,967; 92%), smokers (60,543; 76%), and asymptomatic (43,074; 54%). Contralateral stenosis ≥70% was present in 8033 (10%) with 2239 (3%) having contralateral occlusion. In 491 (0.6%) patients, peri-operative non-ipsilateral stroke occurred. After characterising univariable associations, logistic regression identified independent drivers of non-ipsilateral stroke after CEA. Operative urgency (p = .001), symptomatic disease (p < .001) and contralateral occlusion (p = .001) were pre-operative drivers. Operative predictors included shunt use (p = .008), CEA with cardiac surgery (p = .013), and CEA with concomitant proximal ipsilateral endovascular intervention (p = .01). Use of dextran (p = .005) and anti-angiotensin therapy (p = .03) were protective. Reperfusion syndrome (p < .001), re-exploration (p < .001), myocardial infarction (p < .001), and intravenous treatment of hypotension (p < .001) or hypertension (p < .001) were post-operative correlates. Non-ipsilateral stroke 30 day mortality was less than ipsilateral stroke (6.1% vs. 10.3%; p = .007). Five year survival after non-ipsilateral stroke was 73%, and no different from ipsilateral stroke 76% (p = .16). Both were worse than without stroke (88%; p < .001).
Conclusion:
Non-ipsilateral stroke after CEA is rare. Features driving risk surround global disease burden, combined procedures, and haemodynamic fluctuations. Contralateral occlusion independently increases non-ipsilateral stroke risk. Regardless of laterality or location, effects of stroke after CEA on long-term survival are similar.
More Related Videos
Related Concept Videos
01:37Energy to Drive Translocation
Generally, polypeptides are unfolded by two distinct...
01:12Relative Risk
02:15M-Cdk Drives Transition Into Mitosis
Cyclin-dependent kinases, or Cdks, work in concert with cyclins to control cell cycle transitions. M-Cdk, a complex of Cdk1 bound to M cyclin, is a well-known example of this coordinated control that drives the transition from the G2 to the M phase.
M cyclin...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:27Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
01:27Drive-Reduction Theory: Push Theory of Motivation