Contralateral Internal Carotid Occlusion Does Not Increase the Periprocedural Risk of Carotid Stenting

BACKGROUND: Carotid artery stenting (CAS) is gaining growing acceptance in the management of carotid stenosis. However, the safety of this approach in patients with contralateral carotid occlusion has not been well established. The goal of this study is to assess whether the presence of contralateral carotid occlusion increases the periprocedural and 30-day postprocedural risk of CAS.
METHODS: We reviewed 247 consecutive carotid stent procedures performed at our institution from July 1, 2004 through July 31, 2007. During this period we compared 26 patients who underwent carotid stenting in the presence of a contralateral carotid occlusion (Group I) with 221 demographically similar patients who underwent carotid stenting without contralateral carotid occlusion (Group II). In Group I, 17 patients (65.4%) were symptomatic and 9 patients (34.6%) were asymptomatic. In Group II, 129 patients (58.4%) were symptomatic and 92 patients (41.6%) were asymptomatic. The measured outcomes were bradycardia and/or hypotension, transient ischemic attacks (TIAs), stroke, myocardial infarction (MI), and death in the periprocedural period.
RESULTS: In Group I, 6 patients (23%) suffered hypotension and/or bradycardia (5 patients intraprocedurally and 1 patient intra and postprocedurally), while in Group II, 43 patients (19.4%) suffered bradycardia and/or hypotension (26 intraprocedurally, 7 postprocedurally and 10 intra and postprocedurally) (p = 0.87). No patient suffered TIAs in Group I, while in Group II, 4 patients (1.8%) suffered TIAs ( 1 postprocedurally and 3 intra and postprocedurally) (p = 1.00). No patient suffered a stroke in group I, while in Group II, 5 patient (2.21%) suffered a stroke ( 1 major stroke and 4 minor strokes) (p= 1.00). No patient suffered MI in group I, while in Group II, 2 patients (0.9%) suffered MI (p=1.00). There was no mortality in Group I, while the mortality in Group II was 1 patient (0.45%) (p=1.00).
CONCLUSIONS: CAS in the presence of a contralateral internal carotid occlusion does not increase the periprocedural risk of TIAs, stroke, bradycardia and/or hypotension, MI or death.