Perioperative and follow-up results in carotid artery stenting with contralateral carotid occlusion.

Abstract

Contralateral carotid occlusion (CCO) increases the risk of carotid endarterectomy (CEA). We determined the outcome of carotid angioplasty and stenting (CAS), an alternative to CEA, in the setting of CCO through an independent analysis of imaging and clinical outcome. Medical records of 26 consecutive patients with CCO who underwent CAS by a single operator using the same procedural protocol (with distal protection and closed-cell stents) were retrospectively evaluated. National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores before and after CAS, periprocedural complications, and the restenosis rate were analyzed by independent stroke neurologists who were not involved in the care of the patients. The median mRS score for the 26 patients was 1 (range 0-5) before and after CAS. All of the patients underwent clinical and imaging follow-up (mean 19.5±14.3 and 11.6±11.2months, respectively). Thirty-day mortality/permanent morbidity rates were 0%. One patient had hyperperfusion syndrome and was managed medically without sequelae; however, he had stent occlusion after 30days, resulting in a decline in his mRS from 4 (preprocedure) to 5. Otherwise, there was no decline in mRS during the post-discharge follow-up. According to an independent analysis of this single-operator series, CAS is safe and effective for the treatment of patients with CCO.