title: Management of Bilateral Carotid Occlusive Disease.
abstract: BACKGROUND
  Symptomatic bilateral internal carotid occlusive disease is a rare but potentially devastating entity. Medical therapy alone is associated with high rates of mortality and recurrent stroke. The optimal management of this disease remains poorly understood.
  
  
  METHODS
  A retrospective review of a prospectively maintained database was conducted for patients who presented with an acute stroke in the setting of bilateral carotid occlusive disease between May and October 2013.
  
  
  RESULTS
  We identified 3 patients. The admission National Institutes of Health Stroke Scale score ranged from 4 to 7. All patients had small- to moderate-sized infarcts in the anterior circulation on presentation. Angiography confirmed bilateral internal carotid occlusions with collateral filling via the posterior communicating artery and retrograde filling via external carotid artery supply to the ophthalmic artery. All patients were initially managed with permissive hypertension and anticoagulation followed by carotid angioplasty and stenting. At 1-year follow-up, all patients demonstrated a modified Rankin scale score of 0-1.
  
  
  CONCLUSIONS
  Carotid stenting may be a safe and effective therapy for patients presenting with symptomatic bilateral carotid occlusions.
authors.affiliation: Departments of Neurology and Neurosurgery, UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA.
authors.forename: Ashutosh P
authors.initials: AP
authors.lastname: Jadhav
authors.affiliation: Departments of Neurology and Neurosurgery, UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Ducruet
authors.affiliation: Departments of Neurology and Neurosurgery, UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Jankowitz
authors.affiliation: Departments of Neurology and Neurosurgery, UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA.
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
keywords: Acute stroke; Carotid occlusion; Intervention; Revascularization