External carotid artery stenting to treat patients with symptomatic ipsilateral internal carotid artery occlusion: a multicenter case series.
BACKGROUND
The external carotid artery (ECA) anastomoses in many distal territories supplied by the internal carotid artery (ICA) and is an important source of collateral circulation to the brain. Stenosis of the ECA in ipsilateral ICA occlusion can produce ischemic sequelae.


OBJECTIVE
To examine the effectiveness of ECA stenting in treating symptomatic ipsilateral ICA occlusion.


METHODS
We retrospectively reviewed patient databases from 5 academic medical centers to identify all individuals who underwent ECA stenting after 1998. For all discovered cases, coinvestigators used a common submission form to harvest relevant demographic information, clinical data, procedural details, and follow-up results for further analysis.


RESULTS
Twelve patients (median age, 66 years; range, 45-79 years) were identified for our cohort. Vessel disease involvement included severe ECA stenosis >or= 70% in 11 patients and ipsilateral ICA occlusion in all patients. Presenting symptoms included signs of transient ischemic attack, stroke, and amaurosis fugax. ECA stenting was associated with preservation of neurological status in 11 patients and resolution of symptoms in 5 patients at a median follow-up time of 26 months (range, 1-87 months; mean, 29 months). Symptomatic in-stent restenosis did not occur within any patient during the follow-up course.


CONCLUSIONS
We found ECA stenting in symptomatic ipsilateral ICA disease to be a potentially effective strategy to preserve neurological function and to relieve ischemic symptoms. Further investigation with larger studies and longer follow-up periods is warranted to elucidate the true indications of this management strategy.
Xu
David S
DS
Departments of Neurological Surgery and Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Abruzzo
Todd A
TA
Albuquerque
Felipe C
FC
Dabus
Guilherme
G
Eskandari
Mark K
MK
Guterman
Lee R
LR
Hage
Ziad A
ZA
Hurley
Michael C
MC
Hanel
Ricardo A
RA
Levy
Elad I
EI
Nichols
Christopher W
CW
Ringer
Andrew J
AJ
Batjer
H Hunt
HH
Bendok
Bernard R
BR
D000368:Aged; D002342:Carotid Artery, External / Q000473:pathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000473:pathology; D016893:Carotid Stenosis / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000150:complications; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000002:abnormalities; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013699:Temporal Arteries / Q000002:abnormalities; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome