Bilateral internal carotid artery occlusion: natural history and surgical alternatives

AbuRahma, Ali F.; Copeland, Sam

doi:10.1016/s0967-2109(98)00072-6

Cited by 32 publications

(42 citation statements)

References 6 publications

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“…Key words in the search included ''common carotid artery occlusion'', ''internal carotid artery occlusion'' and ''bilateral''. There were 105 cases of unilateral CCA occlusion and 209 cases of bilateral ICA occlusion in the literature [1][2][3][8][9][10][11][12][13][14][15][16][17][18][19][20]. Seven cases of bilateral CCA occlusion were found, including six cases [4][5][6][7] reported in the literature and our one case.…”

Section: Methodsmentioning

confidence: 95%

Bilateral common carotid artery occlusion — A case report and literature review

Lai

Chen

Weng

et al. 2005

Journal of the Neurological Sciences

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Section: Methodsmentioning

confidence: 95%

Bilateral common carotid artery occlusion — A case report and literature review

Lai

Chen

Weng

et al. 2005

Journal of the Neurological Sciences

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“…All 3 patients had clinical and radiographic evidence of stroke. In one series of 21 patients presenting with bilateral occlusions, 38% presented with a transient ischemic attack, 14% presented with amaurosis fugax, and 24% presented with strokes [6]. Two of the 3 patients in this study had recurrent events, and the third patient remained somnolent until both carotids were revascularized.…”

Section: Discussionmentioning

confidence: 85%

“…In a series of 8 patients managed with medical therapy and of 13 patients managed with surgery, 8 underwent carotid endarterectomy, 4 carotid-subclavian bypass, and 1 underwent aorta-to-innominate artery bypass. Outcomes in the surgical group included 38% mortality and 15% recurrent events, as compared to 75% mortality and 75% recurrent events in the medical therapy group [6]. While surgery appears to be superior to medical therapy alone, the hemodynamic instability of this population may make general anesthesia and the associated risks of open microsurgery intolerable for a subset of these patients [23].…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis including 70 patients with bilateral occlusions revealed a 20% rate of recurrent stroke in this population [6]. In a series of 21 patients with a mean follow-up of 6 years, the mortality for symptomatic bilateral carotid occlusive disease was 52%.…”

Section: Introductionmentioning

confidence: 99%

“…In a series of 21 patients with a mean follow-up of 6 years, the mortality for symptomatic bilateral carotid occlusive disease was 52%. Surgical revascularization (via carotid endarterectomy or bypass) was associated with lower rates of death, suggesting that revascularization may lead to improved outcomes over medical management [6]. …”

Section: Introductionmentioning

confidence: 99%

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Management of Bilateral Carotid Occlusive Disease

et al. 2015

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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.

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Bilateral carotid artery occlusion with transient or moderately disabling ischaemic stroke: clinical features and long-term outcome

et al. 2009

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Information on the prognosis of patients with transient ischaemic attack or moderately disabling ischaemic stroke associated with bilateral internal carotid artery (ICA) occlusion is scarce. We prospectively studied 57 consecutive patients (46 men; mean age 60 ± 9 years) with bilateral ICA occlusion who had presented with unilateral transient or moderately disabling cerebral or retinal ischaemic symptoms. We determined the long-term risk of recurrent ischaemic stroke and the composite outcome of stroke, myocardial infarction or vascular death. Four patients had a recurrent ischaemic stroke during a mean follow-up of 5.9 years, resulting in an annual stroke rate of 1.2% (95% confidence interval (CI) 0.3-3.1). Risk factors for recurrent ischaemic stroke could not be identified. Eighteen patients suffered a stroke, myocardial infarction or vascular death, resulting in an annual rate for major vascular events of 5.3% (95% CI 3.1-8.3). Age and a history of ischaemic heart disease were significant risk factors for future vascular events. Patients with transient or moderately disabling symptoms of cerebral or retinal ischaemia associated with bilateral ICA occlusion have a relatively low risk of recurrent ischaemic stroke. Although this study was not designed to compare conservative treatment with surgical intervention, the favourable outcome suggests that a policy of medical therapy and control of risk factors may be justified in these patients.

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Bilateral internal carotid artery occlusion: natural history and surgical alternatives

Cited by 32 publications

References 6 publications

Bilateral common carotid artery occlusion — A case report and literature review

Bilateral common carotid artery occlusion — A case report and literature review

Management of Bilateral Carotid Occlusive Disease

Bilateral carotid artery occlusion with transient or moderately disabling ischaemic stroke: clinical features and long-term outcome

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