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Elective carotid artery stenting in the presence of contralateral occlusion
A Mathur1, G S Roubin, C R Gomez
1Department of Medicine, The University of Alabama at Birmingham, USA.
Insights
Carotid stenting offers a safe alternative for patients with significant carotid stenosis and contralateral occlusion. This procedure demonstrates high success rates and low stroke risk, improving outcomes for this high-risk group.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Significant carotid stenosis with contralateral occlusion poses a poor prognosis with medical therapy alone.
- Surgical carotid endarterectomy carries risks of stroke due to critical flow reductions in patients with poor collateral circulation.
- Carotid stenting is an emerging alternative to endarterectomy for managing carotid artery disease.
Purpose of the Study:
- To evaluate the immediate and late outcomes of carotid stenting in patients with contralateral carotid occlusion.
- To assess the safety and efficacy of carotid stenting in a high-risk patient cohort.
Main Methods:
- A series of 26 patients with significant carotid stenosis and contralateral carotid occlusion underwent carotid stenting.
- Procedural success, degree of stenosis reduction, and neurological complications were assessed.
- Late follow-up was conducted to evaluate long-term outcomes and stroke incidence.
Main Results:
- Carotid stenting achieved a 96% procedural success rate in this patient group.
- Mean diameter stenosis was significantly reduced from 76% to 2.8%.
- A low incidence of procedural complications (1 minor stroke) and no late neurological events were observed at a mean follow-up of 16 months.
Conclusions:
- Carotid stenting is a successful and safe treatment option for significant carotid stenosis in the presence of contralateral occlusion.
- The procedure offers a low risk of neurological complications and late stroke, providing a viable alternative to surgery for this challenging patient population.
Abstract:
Significant carotid stenosis in the presence of an occluded contralateral artery has a poor prognosis with medical therapy alone. Carotid cross clamping during surgical endarterectomy results in critical flow reductions in patients with inadequate collateral flow, and represents a significant risk for procedural strokes. Carotid stenting is being evaluated as an alternative to endarterectomy. We describe the immediate and late outcome of a series of 26 patients treated with carotid stenting in the presence of contralateral carotid occlusion. The mean age of the patients in this group was 65 +/- 9 years, 23 (89%) were men and 10 (39%) were symptomatic from the vessel treated. The procedural success of carotid stenting in this group of patients was 96%. The mean diameter stenosis was reduced from 76 +/- 15% to 2.8 +/- 5%. There was 1 (3.8%) minor stroke in a patient who developed air embolism during baseline angiography. At late follow-up there was no neurologic event in any patient at a mean of 16 +/- 9.5 months after the procedure. Thus, carotid stenting of lesions with contralateral occlusion can be performed successfully with a low incidence of procedural neurologic complications and late stroke.