Carotid endarterectomy versus stenting in patients with contralateral carotid artery occlusion

Aim. The aim of this prospective study was to compare outcomes after CEA and CAS in patients with contralateral carotid artery occlusion. Methods. Between 2004 and 2009, 527 consecutive patients underwent CEA (N.=281) or CAS (N.=246) for severe stenosis of internal carotid artery (ICA). Of them, 85 (16.1%) were identified with contralateral carotid artery occlusion. CEA was performed in 31 (36.4%) patients with contralateral ICA occlusion, and 15 (48.4%) were symptomatic. Intraoperative shunts were placed in 12% versus 41.9% (P<0.001) patients with patent (N.=250) or occluded contralateral ICA (N.=31). Fifty-four (63.5%) patients with contralateral ICA occlusion underwent CAS with distal protection, and 38 (70.4%) were symptomatic. Results. The ICA occlusion time during CEA was 27.9±2 min, and 5±1 s during balloon inflations in CAS (P<0.001). The perioperative rate of adverse neurologic events was not significantly higher in patients with contralateral ICA occlusion after both CEA (3.22% vs. 1.20%) and CAS (1.85% vs. 1.04%). Also the incidence of the 30-d total stroke/mortality rate was not significantly different (CEA: 6.45% vs. 1.60%; CAS: 3.70% vs. 1.56%). Conclusion. CAS is a safe and efficacious alternative for the treatment of carotid artery stenosis in patients with contralateral occlusion. The avoidance of general anesthesia and other CEA-related factors, and a significantly shorter period of ICA occlusion during balloon inflation can be the reasons for a 1.7-fold decreased risk after CAS.