OBJECT: The risks associated with carotid endarterectomy (CEA) are increased in the presence of contralateral carotid artery (CA) occlusion. The 30-day stroke and death rate for patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) who had contralateral CA occlusion was 14.3%. The authors analyze their experience with angioplasty and/or stent placement in patients with contralateral CA occlusion to determine the safety and efficacy of endoluminal revascularization in this subgroup. METHODS: Twenty-six procedures were evaluated in 23 patients with high-grade CA stenosis and contralateral CA occlusion. The first 15 procedures were evaluated retrospectively, and the next 11 prospectively. All patients had severe medical comorbidities and were considered too high risk for CEA, even without considering the contralateral occlusion. Clinical follow-up review was performed an average of 18 months later (median 15 months). CONCLUSIONS: The average ipsilateral CA stenosis according to NASCET criteria was 78% preprocedure and 5% postprocedure. There were no changes in neurological or functional outcome immediately postoperatively in any patient. The 30-day postoperative stroke and death rates were zero. However, there was one symptomatic femoral hematoma that resolved without surgery. At follow up, there were three patients who had suffered stroke or death. One patient died secondary to respiratory arrest at 2 months; one died secondary to prostate carcinoma at 12 months; and one patient experienced a minor stroke contralateral to the treated artery at 41 months. Despite the substantial preoperative risk factors in patients in this series, the 30-day stroke and death rate for angioplasty and/or stent placement appears to be lower than that of CEA in patients with contralateral occlusions.
OBJECT: The risks associated with carotid endarterectomy (CEA) are increased in the presence of contralateral carotid artery (CA) occlusion. The 30-day stroke and death rate for patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) who had contralateral CA occlusion was 14.3%. The authors analyze their experience with angioplasty and/or stent placement in patients with contralateral CA occlusion to determine the safety and efficacy of endoluminal revascularization in this subgroup. METHODS: Twenty-six procedures were evaluated in 23 patients with high-grade CA stenosis and contralateral CA occlusion. The first 15 procedures were evaluated retrospectively, and the next 11 prospectively. All patients had severe medical comorbidities and were considered too high risk for CEA, even without considering the contralateral occlusion. Clinical follow-up review was performed an average of 18 months later (median 15 months). CONCLUSIONS: The average ipsilateral CA stenosis according to NASCET criteria was 78% preprocedure and 5% postprocedure. There were no changes in neurological or functional outcome immediately postoperatively in any patient. The 30-day postoperative stroke and death rates were zero. However, there was one symptomatic femoral hematoma that resolved without surgery. At follow up, there were three patients who had suffered stroke or death. One patient died secondary to respiratory arrest at 2 months; one died secondary to prostate carcinoma at 12 months; and one patient experienced a minor stroke contralateral to the treated artery at 41 months. Despite the substantial preoperative risk factors in patients in this series, the 30-day stroke and death rate for angioplasty and/or stent placement appears to be lower than that of CEA in patients with contralateral occlusions.
Authors: John D Barr; John J Connors; David Sacks; Joan C Wojak; Gary J Becker; John F Cardella; Bohdan Chopko; Jacques E Dion; Allan J Fox; Randall T Higashida; Robert W Hurst; Curtis A Lewis; Terence A S Matalon; Gary M Nesbit; J Arliss Pollock; Eric J Russell; David J Seidenwurm; Robert C Wallace Journal: AJNR Am J Neuroradiol Date: 2003 Nov-Dec Impact factor: 3.825
Authors: H Fukuda; K Iihara; N Sakai; K Murao; H Sakai; T Higashi; S Kogure; J Takahashi; K Hayashi; I Nagata Journal: Interv Neuroradiol Date: 2004-10-22 Impact factor: 1.610
Authors: Nestor Mercado; David J Cohen; John A Spertus; Paul S Chan; John House; Kevin Kennedy; Ralph G Brindis; Christopher J White; Kenneth A Rosenfield; Steven P Marso Journal: JACC Cardiovasc Interv Date: 2013-01 Impact factor: 11.195
Authors: Glenn M LaMuraglia; David C Brewster; Ashby C Moncure; David J Dorer; Michael C Stoner; Samir K Trehan; Elizabeth C Drummond; William M Abbott; Richard P Cambria Journal: Ann Surg Date: 2004-09 Impact factor: 12.969