Contralateral high-grade carotid artery stenosis or occlusion is not associated with increased risk for poor neurologic outcome after elective carotid stent placement.

Abstract

To compare neurologic outcome after elective internal carotid artery (ICA) stents have been placed in patients with and in patients without contralateral ICA obstructions. This study included 471 consecutive patients from a registry database who underwent elective ICA stent placement without cerebral protection for high-grade (greater than 70% stenosis of the ICA, according to the North American Symptomatic Carotid Endarterectomy Trial) symptomatic (n = 147) or asymptomatic (n = 324) ICA stenosis. Contralateral carotid arteries were investigated with angiography. Patients with and patients without contralateral high-grade stenosis (70%-99% stenosis, according to the North American Symptomatic Carotid Endarterectomy Trial) or occlusion were compared with respect to 30-day neurologic outcome by using the chi2 test and multivariate logistic regression analysis. Neurologic events were observed in 33 patients (7%) with 15 transient ischemic attacks, eight minor strokes, and 10 major strokes that led to death in two patients (combined stroke and death rate, 4%). Eighty-eight patients (19%) with contralateral high-grade ICA stenosis and 43 patients (9%) with contralateral ICA occlusion exhibited a similar rate of postintervention combined neurologic events (n = 9, 7%) compared with patients without contralateral high-grade ICA stenosis or occlusion (n = 24, 7%) (P =.94). No differences were observed between symptomatic and asymptomatic patients. Combined stroke and death rates were also comparable between symptomatic (four of 131, 3%) and asymptomatic (14 of 340, 4%) patients (P =.59). Of all variables tested, multivariate analysis did not detect any predictor for peri- or postinterventional neurologic events. Contralateral high-grade ICA stenosis or occlusion was not associated with an increased risk for neurologic events after elective ICA stent placement.