Difficult clinical decisions regarding carotid artery revascularization in patients with contralateral carotid
Robin Roy Mathews1, László Oláh1, László Csiba1
1University of Debrecen, University of Debrecen Clinical Centre, Health Care Service Units, Clinics, Department of Neurology, Debrecen.
Insights
Optimal management for carotid artery stenosis with contralateral carotid occlusion remains unclear. Recent guidelines suggest stenting (CAS) over endarterectomy (CEA), but some studies favor CEA due to better outcomes.
Area of Science:
- Vascular Surgery
- Neurology
- Stroke Prevention
Background:
- Carotid revascularization via CEA and CAS are standard secondary stroke prevention for unilateral stenosis.
- Optimal management strategies for carotid stenosis with contralateral carotid occlusion (CCO) are less defined despite high stroke risk.
Purpose of the Study:
- To review recent findings on managing carotid stenosis in patients with CCO.
- To suggest future research directions and clinical implications.
Main Methods:
- Systematic literature review utilizing PubMed, ScienceDirect, and Google Scholar.
- Analysis of recent studies comparing carotid endarterectomy (CEA) and carotid artery stenting (CAS) in patients with CCO.
Main Results:
- Current guidelines often recommend CAS over CEA for patients with CCO.
- Contrasting evidence exists, with some studies favoring CEA based on complication and outcome analysis.
Conclusions:
- Treatment decisions for carotid stenosis with CCO are multifactorial, including patient neurological status, comorbidities, age, and imaging findings.
- Further multicenter studies are needed to establish definitive optimal management due to contradictory observations.
Abstract:
Background and purpose - Carotid revascularization through carotid endarterectomy (CEA) and carotid artery stenting (CAS) are well established secondary preventive measures after ischemic stroke in unilateral carotid artery stenosis, but in the presence of contralateral carotid occlusion (CCO) the evidence regarding the optimal management of the stenotic carotid is not as clear even though the risk of ischemic stroke is high. The purpose of our review is to summarize recent findings and suggest its future implications. Methods - We conducted a systematic literature review using PubMed and ScienceDirect databases supplemented with studies found from Google Scholar. Results - Recent guidelines recommend CAS over CEA in patients with CCO, but in contrast some studies favor CEA over CAS after analysis of the complications and clinical outcome. Discussion - The decision between CEA and CAS depends upon a variety of factors such as neurological status, surgical risk factors, medical comorbidities, age, and imaging findings (presence of silent infarcts, plaque characteristics and the state of collateral circulation). Due to the contradictory observations the authors suggest further multicenter studies to establish the optimal management of patients with carotid stenosis and CCO and also summarize their personal opinion.
Related Concept Videos
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:27Coronary Artery Disease V: Interprofessional Care
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests