Elective carotid artery stenting in the presence of contralateral occlusion.
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.
Mathur
A
A
Department of Medicine, The University of Alabama at Birmingham, USA.
Roubin
G S
GS
Gomez
C R
CR
Iyer
S S
SS
Wong
P M
PM
Piamsomboon
C
C
Yadav
S S
SS
Dean
L S
LS
Vitek
J J
JJ
D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000628:therapy*; D002561:Cerebrovascular Disorders / Q000209:etiology; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome