title: Carotid artery stenting in the presence of contralateral carotid occlusion: mind the hyperperfusion syndrome!
abstract: Stroke is the third cause of death in western countries and its complications lead to significant socio-economic problems related to the prolonged hospitalization and rehabilitation of patients with neurological lesions. Severe atherosclerotic lesions of the carotid artery are the main cause of stroke and transient ischemic attacks. Their incidence may reach 5-7% per year in patients with carotid artery stenosis > 70% with or without symptoms. Time-honored carotid endarterectomy is still regarded as the gold standard therapy for primary and secondary prevention of stroke. However, surgery is not free of complications and the rate of perioperative stroke ranges from 5.1 to 14.3%. A group of patients at a particularly high risk of stroke during surgical endarterectomy is represented by patients with significant carotid stenosis in the presence of an occluded contralateral artery. Indeed, carotid cross-clamping during operative surgery in the absence of an adequate collateral flow may result in a critical flow reduction during the operation and therefore increases the risk of periprocedural strokes. In the North American Symptomatic Carotid Endarterectomy (NASCET) trial, the overall risk of stroke was 5.1%, whereas it increased up to 14.3% in patients with an occluded contralateral carotid artery. Recently, carotid stenting has been increasingly used as an endovascular technique for carotid revascularization, especially after the introduction of neuroprotection devices which improved the safety of the procedure. Therefore, it may be an attractive alternative to carotid endarterectomy, especially when the surgical risk is too high. We describe the immediate and late outcomes of 3 patients treated with carotid artery stenting in the presence of contralateral carotid occlusion.
authors.affiliation: Cardiovascular Department, University of Catania, Ferrarorto Hospital-Postgraduate School in Cardiology, Catania, Italy. antoninon@hotmail.com
authors.forename: Antonino
authors.initials: A
authors.lastname: Nicosia
authors.forename: Emanuele
authors.initials: E
authors.lastname: Leotta
authors.forename: Sharam
authors.initials: S
authors.lastname: Moshiri
authors.forename: Alfredo R
authors.initials: AR
authors.lastname: Galassi
authors.forename: Rossella
authors.initials: R
authors.lastname: Barbagallo
authors.forename: Daniela
authors.initials: D
authors.lastname: Santonocito
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Valeria
authors.initials: V
authors.lastname: Calvi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giuffrida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery*; D003097:Collateral Circulation / Q000502:physiology; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional