Effectiveness and safety of carotid artery stenting for significant carotid stenosis in patients with contralateral occlusion (from the German ALKK-CAS Registry experience).
Data on the safety of carotid artery stenting (CAS) in a large number of unselected patients with contralateral occlusion and significant ipsilateral stenosis are less known. Accordingly, we evaluated 3,137 patients undergoing CAS who were enrolled in a German Registry from 2000 to 2008 and compared the clinical features and in-hospital outcomes of those with and without contralateral carotid occlusion. Contralateral carotid occlusion was present in 191 patients (6.1%) undergoing CAS. Despite the similar age of the patients with and without contralateral carotid occlusion, those with contralateral occlusion had a greater prevalence of co-morbidities, complex carotid stenosis, and greater number of focal neurologic lesions on the contralateral side. The incidence of in-hospital events, including death (1.0% vs 0.5%), ipsilateral major stroke (1.1% vs 1.1%), death or major ipsilateral stroke (1.6% vs 1.4%), ipsilateral transient ischemic attack (2.7% vs 2.5%), myocardial infarction (0.0% vs 0.1%), and reintervention (0.5% vs 1.1%), was low and was not significantly different between those with and without contralateral occlusion (p >0.05 for all comparisons). Among patients with carotid occlusion, major ipsilateral stroke (2.2%), death (2.2%), and a combination of these 2 events (3.3%) were observed exclusively in symptomatic patients with no event in asymptomatic patients. In conclusion, our data from a large number of patients undergoing CAS in a recent contemporary community-based practice attests to the low risk of periprocedural events among patients with contralateral carotid occlusion supporting CAS as an attractive option for the treatment of these patients.
Mehta
Rajendra H
RH
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA. mehta007@dcri.duke.edu
Zahn
Ralf
R
Hochadel
Matthias
M
Mudra
Harald
H
Ischinger
Thomas
T
Hauptmann
Karl-Eugen
KE
Jung
Jens
J
Seggewiss
Hubert
H
Zeymer
Uwe
U
Senges
Jochen
J
D000800:Angioplasty, Balloon; D016893:Carotid Stenosis / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D012042:Registries; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome