Carotid Artery Stenting for Patients With Carotid Stenosis and Contralateral Carotid Artery Occlusion: A 12-Year Experience

Background: Carotid artery stenting (CAS) has emerged as a potential alternative for treating patients with extracranial cerebrovascular diseases. Contralateral carotid artery occlusion (CCO) occurs in approximately 2.3% to 25% of patients with carotid artery stenosis. However, the association of a CCO with long-term outcomes after CAS remains unclear. Here, we aimed to evaluate the perioperative and long-term recovery and safety of patients with CCO after receiving CAS.Methods: We retrospectively collected the data of patients with CCO treated with CAS between 2010 and 2021. The primary end point was a nonfatal major stroke. The secondary end points included cerebral hemorrhage, nonfatal myocardial infarction, restenosis, acute renal insuffi-ciency, stent-related complications, and death. Long-term outcomes were analyzed by Kaplan-Meier survival analysis using the following variables: symptomatic carotid stenosis, age, stent type, collateral flow status, and postdilation.Results: Seventy one consecutive patients with CCO who underwent CAS were included in the study. Of these, 61 patients (86%) were followed up for 9-134 months, with an average of 63.3 +/- 30.4 months. In the perioperative period, 2 patients (2.8%) experienced stroke and 1 pa-tient (1.4%) died due to cerebral hemorrhage combined with cerebral hernia. During follow-up, 2 patients (3.3%) developed stroke at 4 and 6 months each after CAS and 6 patients (9.8%) died (2 patients died due to myocardial infarction and 4 patients died due to either severe liver failure, car accident, cervical fracture, or unknown cause). Kaplan-Meier survival analysis showed that symptomatic carotid stenosis, age, stent type, and postdilation were not associated with long-term stroke (P<0.05). The inadequate collateral flow group showed a higher stroke rate than the control group (P 1/4 0.009).Conclusions: CAS is a safe and effective therapy for patients with CCO. Inadequate collateral flow is associated with a higher long-term rate of stroke. Our findings revealed that symptomatic carotid stenosis, age, stent type, and postdilation had no significant effect on outcome events after CAS.