Does a contralateral carotid occlusion adversely impact carotid artery stenting outcomes?

Ann Vasc Surg 2012 Jan 1;26(1):40-5. Epub 2011 Oct 1.

Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.

Background: Carotid artery stenting (CAS) has grown as a possible alternative for the treatment of extracranial cerebrovascular disease in the past decade. A preexisting contralateral carotid artery occlusion has been described as a risk factor for inferior outcomes after carotid endarterectomy, but its impact on CAS outcomes is less understood.

Methods: A retrospective review of 417 CAS procedures performed between May 2001 and July 2010 at a single center using self-expanding nitinol stents and mechanical embolic protection devices was conducted. Patients were divided into two groups, those with a preexisting contralateral carotid occlusion (group A, n = 39) versus those without a contralateral occlusion (group B, n = 378). Patient demographics and comorbidities as well as 30-day and late death, stroke, and myocardial infarction (MI) rates were analyzed. Mean follow-up was 4 years (range: 0-9.4 years).

Results: Overall, mean age of the 314 men and 103 women was 70.5 years. In group A, there were two (5.1%) octogenarians and nine patients (23.1%) with symptomatic disease as compared with group B with 53 (14%) octogenarians and 121 (32%) patients with symptomatic disease. The overall 30-day death, stroke, and MI rates were 0.5%, 1.9%, and 0.7%, respectively. When comparing group A with group B, these results were not significantly different: death (0% vs. 0.5%), stroke (2.6% vs. 1.9%), and MI (0% vs. 0.8%). Long-term outcomes for groups A and B were also not significantly different: death (25.6% vs. 22.2%), stroke (5.3% vs. 3.4%), and MI (15.4% vs. 14%) (p = nonsignificant).

Conclusion: A preexisting contralateral carotid artery occlusion does not seem to adversely impact CAS outcomes.

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Source
http://dx.doi.org/10.1016/j.avsg.2011.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3242852PMC
January 2012
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