Carotid artery angioplasty and use of stents in high-risk patients with contralateral occlusions

Robert A. Mericle, Stanley H. Kim, Giuseppe Lanzino, Demetrius K. Lopes, Ajay K. Wakhloo, Lee R. Guterman, L. Nelson Hopkins

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

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 fit 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.

Original languageEnglish (US)
Pages (from-to)1031-1036
Number of pages6
JournalJournal of Neurosurgery
Volume90
Issue number6
StatePublished - Jun 1999
Externally publishedYes

Fingerprint

Angioplasty
Carotid Arteries
Stents
Carotid Endarterectomy
Stroke
Carotid Stenosis
Mortality
Thigh
Hematoma
Comorbidity
Prostate
Arteries
Carcinoma
Safety

Keywords

  • Angioplasty
  • Carotid artery occlusion
  • Carotid artery stenosis
  • Contralateral occlusion
  • Endovascular therapy
  • Stent

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Mericle, R. A., Kim, S. H., Lanzino, G., Lopes, D. K., Wakhloo, A. K., Guterman, L. R., & Hopkins, L. N. (1999). Carotid artery angioplasty and use of stents in high-risk patients with contralateral occlusions. Journal of Neurosurgery, 90(6), 1031-1036.

Carotid artery angioplasty and use of stents in high-risk patients with contralateral occlusions. / Mericle, Robert A.; Kim, Stanley H.; Lanzino, Giuseppe; Lopes, Demetrius K.; Wakhloo, Ajay K.; Guterman, Lee R.; Hopkins, L. Nelson.

In: Journal of Neurosurgery, Vol. 90, No. 6, 06.1999, p. 1031-1036.

Research output: Contribution to journalArticle

Mericle, RA, Kim, SH, Lanzino, G, Lopes, DK, Wakhloo, AK, Guterman, LR & Hopkins, LN 1999, 'Carotid artery angioplasty and use of stents in high-risk patients with contralateral occlusions', Journal of Neurosurgery, vol. 90, no. 6, pp. 1031-1036.
Mericle RA, Kim SH, Lanzino G, Lopes DK, Wakhloo AK, Guterman LR et al. Carotid artery angioplasty and use of stents in high-risk patients with contralateral occlusions. Journal of Neurosurgery. 1999 Jun;90(6):1031-1036.
Mericle, Robert A. ; Kim, Stanley H. ; Lanzino, Giuseppe ; Lopes, Demetrius K. ; Wakhloo, Ajay K. ; Guterman, Lee R. ; Hopkins, L. Nelson. / Carotid artery angioplasty and use of stents in high-risk patients with contralateral occlusions. In: Journal of Neurosurgery. 1999 ; Vol. 90, No. 6. pp. 1031-1036.
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abstract = "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 fit 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.",
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AU - Mericle, Robert A.

AU - Kim, Stanley H.

AU - Lanzino, Giuseppe

AU - Lopes, Demetrius K.

AU - Wakhloo, Ajay K.

AU - Guterman, Lee R.

AU - Hopkins, L. Nelson

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N2 - 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 fit 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.

AB - 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 fit 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.

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