Document Detail

Carotid artery angioplasty and use of stents in high-risk patients with contralateral occlusions.
MedLine Citation:
PMID:  10350248     Owner:  NLM     Status:  MEDLINE    
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 at 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.
R A Mericle; S H Kim; G Lanzino; D K Lopes; A K Wakhloo; L R Guterman; L N Hopkins
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  90     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  1999 Jun 
Date Detail:
Created Date:  1999-06-14     Completed Date:  1999-06-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1031-6     Citation Subset:  AIM; IM    
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 14209-1194, USA.
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MeSH Terms
Aged, 80 and over
Arterial Occlusive Diseases / radiography,  therapy*,  ultrasonography
Carotid Artery Diseases / radiography,  therapy*,  ultrasonography
Cerebral Angiography
Follow-Up Studies
Middle Aged
Postoperative Complications
Prospective Studies
Retrospective Studies
Risk Factors
Treatment Outcome
Ultrasonography, Doppler

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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