Results of carotid stenting in patients with contralateral internal carotid artery occlusion: a retrospective single-center analysis and 22 years of experience

Purpose: Patients with contralateral carotid artery occlusion (CCO) represent a subgroup of patients at risk for revascularization procedures. The choice of appropriate revascularization procedure (carotid endarterectomy (CEA) or carotid artery stenting (CAS)) in these patients is controversial. The aim of this study is to share the results of clinical and radiological follow-up after CAS in these patients and to contribute to the literature by evaluating the efficacy and safety of stenting.

Methods: In our study, the clinical and radiological data of 145 patients with CCO and 145 age-gender-matched patients without CCO who underwent elective CAS in the interventional neuroradiology clinic between 2001 and 2023 were retrospectively analyzed. A comparison was made between short- and long-term outcomes between the two groups.

Results: The overall technical success rate of CAS was 99.7% and the 30-day all-cause mortality rate was 1.4%. There was no statistically significant difference between the two groups in terms of early-term (intra-procedural thromboembolic events, post-procedural symptomatic hyperperfusion, intraparenchymal hemorrhage, major and minor ischemic stroke, early-term mortality rate) and long-term (intimal hyperplasia, residual stenosis, major and minor ischemic stroke and long-term all-cause mortality rate) (p > 0.05).

Conclusion: In our experience, it was concluded that CAS performed by an experienced interventional neuroradiology team in patients with CCO does not pose an additional risk. Since CCO poses a risk for CAE, CAS may be a more acceptable treatment modality in these patients due to less perioperative risk. However, further research is required to support our findings.