Impact of contralateral carotid or vertebral artery occlusion in patients undergoing carotid endarterectomy or carotid artery stenting

Abstract

CAS was followed by a significantly higher frequency of ESNC and postprocedural stroke compared with CEA. By subgroup analysis, CCO was a risk factor for ESNC but not for postprocedural stroke alone in patients undergoing CEA. Unilateral or bilateral VAO was not associated with a higher rate of ESNC or stroke in CEA or CAS.

Treatment Strategy for Bilateral Carotid Stenosis: 2 Cases of Carotid Endarterectomy for the Symptomatic Side Followed by Carotid Stenting

“…Although several reports have confirmed that contralateral carotid occlusion does not adversely affect CAS [22][23][24] , previous studies have shown conflicting results regarding the perioperative risk of the patients with contralateral ICA occlusion undergoing CEA 22,24,[27][28][29][30][31] . Antoniou et al conducted a systematic review, and showed contralateral occlusion increases the incidence of perioperative strokes 27 .…”

“…One of the problems of this strategy is the higher incidence of post procedural hemodynamic complications. Although contralateral carotid occlusion does not adversely impact CAS [22][23][24] , there have been no reports indicating that CAS is safer in patients with contralateral severe ICA stenosis than is CEA. Rather, we think that hypotension after CAS for the asymptomatic side may be dangerous for the symptomatic hemisphere, because CAS for the asymptomatic side usually does not improve hemodynamics in the symptomatic cerebral hemisphere.…”

Carotid Endarterectomy with Routine Shunt for Patients with Contralateral Carotid Occlusion

“…4,5,[12][13][14] There were no clear indications for the treatment of this subgroup of patients. Some researchers found that CCO did not increase the incidence of complications during carotid artery stenting procedure and argued that this procedure was superior to CEA for the treatment of patients with CCO.…”

“…[3][4][5] Approximately, 10% of patients with carotid stenosis have coexisting CCO. 6) A study which focused on the natural history of patients with carotid stenosis and CCO reported that patients with CCO had a higher incidence of stroke compared to those without CCO.…”

Surgical Outcomes for Cervical Carotid Artery Stenosis: Treatment Strategy for Bilateral Cervical Carotid Artery Stenosis

“…On the other hand, they thought that CAS would be better for the first revascularization procedure than CEA because CCS would adversely affect CEA. 17,18 Although CCO does not adversely impact CAS, [29][30][31] there have been no reports indicating that CAS is safer in patients with contralateral severe ICA stenosis than is CEA. In fact, contralateral occlusion is one of the risk factors in Protected…”