Safety and security of carotid artery stenting for severe stenosis with contralateral occlusion.
BACKGROUND
Despite advances in the surgical treatment of patients with severe internal carotid stenosis (ICA), there are selective groups of patients who, due to several reasons, are not good candidates for surgery. Patients with contralateral occlusion are one of these subgroups. Thereby, other therapeutic alternatives, such as angioplasty may be of value. So far, there has been little published data about carotid angioplasty (CA) or stenting (CAS) in those patients. The objective of this study was to evaluate the efficacy and safety of angioplasty and stenting in patients with severe internal carotid stenosis and contralateral occlusion.


METHODS
Between 1991 and June 2004, 519 consecutive patients who underwent CA or CAS for severe stenosis of the ICA were registered in our prospective CA Data Bank. Of them, we identified 96 with contralateral occlusion (18.5%), who formed the basis of the present analysis.


RESULTS
Mean age was 64 +/- 9 (range 40-80), 85 (88.5%) were men, and 61 (63.5%) were symptomatic. Thirty-two patients (33.3%) did not meet the criteria to be included in the NASCET. CA was done in 25 patients (26%) and CAS in 71 (74%). Distal protection was used in 38 patients (39.6%). Asymptomatic stenosis was treated in cases of progression (>85%), exhausted vasoreactivity, positive microemboli detection in transcranial Doppler, and/or asymptomatic lesions in CT/MRI. Transient hemodynamic effects were frequent: hypotension (54.5%), bradycardia (61.5%), asystole (33.3%), and syncope (33.3%). TIA occurred in 1 patient (1%), minor stroke in 1 (1%), and disabling stroke in 2 patients (2.1%). Mortality was 0%. Morbidity was 0% in cases done with distal protection.


CONCLUSIONS
In our experience, CA/CAS performed in patients with severe carotid stenosis and contralateral occlusion compared favorably with the results obtained with carotid endarterectomy (CEA), to the extent that if randomized series comparing CEA and CA/CAS are done, CA/CAS might be considered as the treatment of choice in this subgroup of patients.
González
Alejandro
A
Department of Radiology, Interventional Neuroradiology, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain.
González-Marcos
Jose Ramón
JR
Martínez
Eva
E
Boza
Fernando
F
Cayuela
Aurelio
A
Mayol
Antonio
A
Gil-Peralta
Alberto
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002339:Carotid Arteries / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000473:pathology; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000473:pathology / Q000517:prevention & control; D014057:Tomography, X-Ray Computed