[Strategy for revascularization of chronic carotid occlusion with contralateral carotid stenosis].
OBJECTIVE
The optimal therapeutic approach for chronic carotid occlusion with contralateral carotid stenosis (ICO-ICS) remains uncertain. The aim of this study was to elucidate the safety and efficacy of initial vascular reconstruction for ICS in patients with ICO-ICS.


METHODS
Eleven patients with ICO-ICS who demonstrated severe cerebral hypoperfusion in the hemisphere ipsilateral to ICO were treated in our institution between February 2003 and November 2007. Revascularization for ICS after measuring cerebral blood flow (CBF) by single photon emission computed tomography (SPECT) was performed either by carotid endarterectomy or carotid stenting. External carotid artery-internal carotid artery (EC-IC) bypass for ICO was also performed when SPECT after revascularization for ICS still demonstrated marked hypoperfusion.


RESULTS
In 6 patients with collateral flow via the anterior communicating artery and/or who had high-grade ICS (>70%), sufficient improvement of CBF solely by revascularization for ICS was confirmed. With regard to perioperative complications, 2 patients suffered bradycardia and hypotension and another 2 showed asymptomatic cerebral infarction on diffusion-weighted magnetic resonance imaging.


CONCLUSIONS
Overall results for revascularization of ICS prior to that for ICO in patients with ICO-ICS were acceptable. CBF of bilateral hemispheres was sufficiently improved in more than half of the patients solely by revascularization for ICS. This strategy might be both efficient and effective for ICO-ICS.
Fukumitsu
Ryu
R
Department of Neurosurgery, Kurashiki Central Hospital, Japan.
Yoshida
Kazumichi
K
Sadamasa
Nobutake
N
Narumi
Osamu
O
Chin
Masaki
M
Yamagata
Sen
S
D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications*; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation; D002908:Chronic Disease; D016894:Endarterectomy, Carotid; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome