Does A Contralateral Carotid Occlusion Adversely Impact CAS Outcomes?

Background—Carotid artery stenting (CAS) has grown as a possible alternative for the treatment of extracranial cerebrovascular disease in the past decade. A pre-existing contralateral carotid artery occlusion has been described as a risk factor for inferior outcomes following carotid endarterectomy (CEA), yet its impact on CAS outcomes is less understood. Methods—Retrospective review of 417 CAS procedures from May 2001 through July 2010 at a single center using self-expanding nitinol stents and mechanical embolic protection devices. Patients were divided into those with a pre-existing contralateral carotid occlusion (Group A, n=39) versus those without a contralateral occlusion (Group B, n=378). Patient demographics and co-morbidities as well as 30-day and late death, stroke, and myocardial infarction (MI) rates were analyzed. Mean follow-up was 4.0 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 2 (5.1%) octogenarians and 9 patients (23.1%) with symptomatic disease as compared to Group B with 53 (14.0%) octogenarians and 121 (32.0%) patients with symptomatic disease. The overall 30-day death, stroke, and MI rates were 0.5%, 1.9%, and 0.7%. When comparing Group A to 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 not significantly different: death (25.6 % vs 22.2%), stroke (5.3 % vs 3.4%), and MI (15.4 % vs 14.0%) (p=NS). Conclusion—A pre-existing contralateral carotid artery occlusion does not appear to adversely impact CAS outcomes