title: Does a contralateral carotid occlusion adversely impact carotid artery stenting outcomes?
abstract: BACKGROUND
  Carotid artery stenting (CAS) has grown as a possible alternative for the treatment of extracranial cerebrovascular disease in the past decade. A preexisting contralateral carotid artery occlusion has been described as a risk factor for inferior outcomes after carotid endarterectomy, but its impact on CAS outcomes is less understood.
  
  
  METHODS
  A retrospective review of 417 CAS procedures performed between May 2001 and July 2010 at a single center using self-expanding nitinol stents and mechanical embolic protection devices was conducted. Patients were divided into two groups, those with a preexisting contralateral carotid occlusion (group A, n = 39) versus those without a contralateral occlusion (group B, n = 378). Patient demographics and comorbidities as well as 30-day and late death, stroke, and myocardial infarction (MI) rates were analyzed. Mean follow-up was 4 years (range: 0-9.4 years).
  
  
  RESULTS
  Overall, mean age of the 314 men and 103 women was 70.5 years. In group A, there were two (5.1%) octogenarians and nine patients (23.1%) with symptomatic disease as compared with group B with 53 (14%) octogenarians and 121 (32%) patients with symptomatic disease. The overall 30-day death, stroke, and MI rates were 0.5%, 1.9%, and 0.7%, respectively. When comparing group A with group B, these results were not significantly different: death (0% vs. 0.5%), stroke (2.6% vs. 1.9%), and MI (0% vs. 0.8%). Long-term outcomes for groups A and B were also not significantly different: death (25.6% vs. 22.2%), stroke (5.3% vs. 3.4%), and MI (15.4% vs. 14%) (p = nonsignificant).
  
  
  CONCLUSIONS
  A preexisting contralateral carotid artery occlusion does not seem to adversely impact CAS outcomes.
authors.affiliation: Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Keldahl
authors.forename: Michael S
authors.initials: MS
authors.lastname: Park
authors.forename: Manuel
authors.initials: M
authors.lastname: Garcia-Toca
authors.forename: Chih-Hsiung E
authors.initials: CH
authors.lastname: Wang
authors.forename: Melina R
authors.initials: MR
authors.lastname: Kibbe
authors.forename: Heron E
authors.initials: HE
authors.lastname: Rodriguez
authors.forename: Mark D
authors.initials: MD
authors.lastname: Morasch
authors.forename: Mark K
authors.initials: MK
authors.lastname: Eskandari
mesh_terms: D000368:Aged; D000497:Alloys; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009436:Neural Tube Defects; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014481:United States / Q000453:epidemiology
chemical_list: D000497:Alloys; C013616:nitinol