Does a Contralateral Carotid Occlusion Adversely Impact Carotid Artery Stenting Outcomes?

Overview

Journal Ann Vasc Surg

Publisher Elsevier

Specialties Cardiology & Vascular Diseases
General Surgery

Date 2011 Oct 4

PMID 21963325

Citations 4

Authors

Mark L Keldahl

Michael S Park

Manuel Garcia-Toca

Chih-Hsiung E Wang

Melina R Kibbe

Heron E Rodriguez

Mark D Morasch

Mark K Eskandari

Affiliations

Soon will be listed here.

Abstract

Background: Carotid artery stenting (CAS) has grown as a possible alternative for the treatment of extracranial cerebrovascular disease in the past decade. A preexisting contralateral carotid artery occlusion has been described as a risk factor for inferior outcomes after carotid endarterectomy, but its impact on CAS outcomes is less understood.

Methods: A retrospective review of 417 CAS procedures performed between May 2001 and July 2010 at a single center using self-expanding nitinol stents and mechanical embolic protection devices was conducted. Patients were divided into two groups, those with a preexisting contralateral carotid occlusion (group A, n = 39) versus those without a contralateral occlusion (group B, n = 378). Patient demographics and comorbidities as well as 30-day and late death, stroke, and myocardial infarction (MI) rates were analyzed. Mean follow-up was 4 years (range: 0-9.4 years).

Results: Overall, mean age of the 314 men and 103 women was 70.5 years. In group A, there were two (5.1%) octogenarians and nine patients (23.1%) with symptomatic disease as compared with group B with 53 (14%) octogenarians and 121 (32%) patients with symptomatic disease. The overall 30-day death, stroke, and MI rates were 0.5%, 1.9%, and 0.7%, respectively. When comparing group A with group B, these results were not significantly different: death (0% vs. 0.5%), stroke (2.6% vs. 1.9%), and MI (0% vs. 0.8%). Long-term outcomes for groups A and B were also not significantly different: death (25.6% vs. 22.2%), stroke (5.3% vs. 3.4%), and MI (15.4% vs. 14%) (p = nonsignificant).

Conclusion: A preexisting contralateral carotid artery occlusion does not seem to adversely impact CAS outcomes.

Citing Articles

Results of carotid stenting in patients with contralateral internal carotid artery occlusion: a retrospective single-center analysis and 22 years of experience.

Kizilkilic E, Akan Y, Atbas B, Karagoz S, Korkmazer B, Arslan S Neuroradiology. 2024; 67(2):393-401.

PMID: 39708158 DOI: 10.1007/s00234-024-03524-7.

Does contralateral carotid artery occlusion affect the clinical and long-term outcomes of carotid artery stenting?.

Can Y, Kocayigit I Arch Med Sci Atheroscler Dis. 2021; 5:e13-e19.

PMID: 33585720 PMC: 7863550. DOI: 10.5114/amsad.2020.92723.

Perioperative and follow-up results in carotid artery stenting with contralateral carotid occlusion.

Peker A, Sorgun M, Togay Isikay C, Arsava E, Topcuoglu M, Arat A Jpn J Radiol. 2016; 34(7):523-8.

PMID: 27230906 DOI: 10.1007/s11604-016-0554-2.

Contralateral occlusion increases the risk of neurological complications associated with carotid endarterectomy.

Capoccia L, Sbarigia E, Rizzo A, Pranteda C, Menna D, Sirignano P Int J Vasc Med. 2015; 2015:942146.

PMID: 25705519 PMC: 4326273. DOI: 10.1155/2015/942146.

References

Theiss W, Hermanek P, Mathias K, Bruckmann H, Dembski J, Hoffmann F . Predictors of death and stroke after carotid angioplasty and stenting: a subgroup analysis of the Pro-CAS data. Stroke. 2008; 39(8):2325-30. DOI: 10.1161/STROKEAHA.108.514356. View

Goodney P, Likosky D, Cronenwett J . Factors associated with stroke or death after carotid endarterectomy in Northern New England. J Vasc Surg. 2008; 48(5):1139-45. DOI: 10.1016/j.jvs.2008.05.013. View

Maatz W, Kohler J, Botsios S, John V, Walterbusch G . Risk of stroke for carotid endarterectomy patients with contralateral carotid occlusion. Ann Vasc Surg. 2007; 22(1):45-51. DOI: 10.1016/j.avsg.2007.07.034. View

Baker W, Howard V, Howard G, Toole J . Effect of contralateral occlusion on long-term efficacy of endarterectomy in the asymptomatic carotid atherosclerosis study (ACAS). ACAS Investigators. Stroke. 2000; 31(10):2330-4. DOI: 10.1161/01.str.31.10.2330. View

Mehta R, Zahn R, Hochadel M, Mudra H, Ischinger T, Hauptmann K . Effectiveness and safety of carotid artery stenting for significant carotid stenosis in patients with contralateral occlusion (from the German ALKK-CAS Registry experience). Am J Cardiol. 2009; 104(5):725-31. DOI: 10.1016/j.amjcard.2009.04.038. View

Pulli R, Dorigo W, Barbanti E, Azas L, Russo D, Matticari S . Carotid endarterectomy with contralateral carotid artery occlusion: is this a higher risk subgroup?. Eur J Vasc Endovasc Surg. 2002; 24(1):63-8. DOI: 10.1053/ejvs.2002.1612. View

Rockman C, Su W, Lamparello P, Adelman M, Jacobowitz G, Gagne P . A reassessment of carotid endarterectomy in the face of contralateral carotid occlusion: surgical results in symptomatic and asymptomatic patients. J Vasc Surg. 2002; 36(4):668-73. View

Touze E, Trinquart L, Chatellier G, Mas J . Systematic review of the perioperative risks of stroke or death after carotid angioplasty and stenting. Stroke. 2009; 40(12):e683-93. DOI: 10.1161/STROKEAHA.109.562041. View

Kastrup A, Groschel K . Carotid endarterectomy versus carotid stenting: an updated review of randomized trials and subgroup analyses. Acta Chir Belg. 2007; 107(2):119-28. View

10.

Mathur A, Roubin G, Gomez C, Iyer S, Wong P, Piamsomboon C . Elective carotid artery stenting in the presence of contralateral occlusion. Am J Cardiol. 1998; 81(11):1315-7. DOI: 10.1016/s0002-9149(98)00161-1. View

11.

Brown K, Usman A, Kibbe M, Morasch M, Matsumura J, Pearce W . Carotid stenting using tapered and nontapered stents: associated neurological complications and restenosis rates. Ann Vasc Surg. 2009; 23(4):439-45. DOI: 10.1016/j.avsg.2008.11.007. View