Carotid Artery Stenting for Patients With Carotid Stenosis and Contralateral Carotid Artery Occlusion: A 12-Year Experience

Abstract

Carotid artery stenting (CAS) has emerged as a potential alternative for treating patients with extracranial cerebrovascular diseases. Contralateral carotid artery occlusion (CCO) occurs in approximately 2.3% to 25% of patients with carotid artery stenosis. However, the association of a CCO with long-term outcomes after CAS remains unclear. Here, we aimed to evaluate the perioperative and long-term recovery and safety of patients with CCO after receiving CAS. We retrospectively collected the data of patients with CCO treated with CAS between 2010 and 2021. The primary endpoint was a nonfatal major stroke. The secondary endpoints included cerebral hemorrhage, nonfatal myocardial infarction (MI), restenosis, acute renal insufficiency, stent-related complications, and death. Long-term outcomes were analyzed by Kaplan-Meier survival analysis using the following variables: symptomatic carotid stenosis, age, stent type, collateral flow status, and post-dilation. Seventy-one consecutive patients with CCO who underwent CAS were included in the study. Of these, 61 patients (86%) were followed up for 9-134 months, with an average of 63.3 ± 30.4 months. In the perioperative period, 2 patients (2.8%) experienced stroke, and 1 patient (1.4%) died due to cerebral hemorrhage combined with cerebral hernia. During follow-up, 2 patients (3.3%) developed stroke at 4 and 6 months each after CAS, and 6 patients (9.8%) died (2 patients died due to MI, and 4 patients died due to either severe liver failure, car accident, cervical fracture, or unknown cause. Kaplan-Meier survival analysis showed that symptomatic carotid stenosis, age, stent type, and post-dilation were not associated with long-term stroke (P＜0.05). The inadequate collateral flow group showed a higher stroke rate than the control group (P = 0.009). CAS is a safe and effective therapy for patients with CCO. Inadequate collateral flow is associated with a higher long-term rate of stroke. Our findings revealed that symptomatic carotid stenosis, age, stent type, and post-dilation had no significant effect on outcome events after CAS.