Risk of Stroke for Carotid Endarterectomy Patients with Contralateral Carotid Occlusion

Maatz, Winfried; Köhler, Jens; Botsios, Spiridon; John, Vincent; Walterbusch, G.

doi:10.1016/j.avsg.2007.07.034

Cited by 43 publications

(37 citation statements)

References 26 publications

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“…207 However, most reports regarding contralateral occlusion do not bear this observation out, and a meta-analysis of the literature suggests a much more modest increase, from 2.4% to 3.7%. 208,209 This was statistically significant, but the results remain within the AHA recommended guidelines. Several single-center studies have shown excellent results in patients with contralateral carotid occlusion.…”

Section: Anatomic and Lesion Characteristicsmentioning

confidence: 69%

Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease

Ricotta

AbuRahma

Ascher

et al. 2011

Journal of Vascular Surgery

558

536

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Management of carotid bifurcation stenosis is a cornerstone of stroke prevention and has been the subject of extensive clinical investigation, including multiple controlled randomized trials. The appropriate treatment of patients with carotid bifurcation disease is of major interest to the community of vascular surgeons. In 2008, the Society for Vascular Surgery published guidelines for treatment of carotid artery disease. At the time, only one randomized trial, comparing carotid endarterectomy (CEA) and carotid stenting (CAS), had been published. Since that publication, four major randomized trials comparing CEA and CAS have been published, and the role of medical management has been re-emphasized. The current publication updates and expands the 2008 guidelines with specific emphasis on six areas: imaging in identification and characterization of carotid stenosis, medical therapy (as stand-alone management and also in conjunction with intervention in patients with carotid bifurcation stenosis), risk stratification to select patients for appropriate interventional management (CEA or CAS), technical standards for performing CEA and CAS, the relative roles of CEA and CAS, and management of unusual conditions associated with extracranial carotid pathology. Recommendations are made using the GRADE (Grades of Recommendation Assessment, Development and Evaluation) system, as has been done with other Society for Vascular Surgery guideline documents.[corrected] The perioperative risk of stroke and death in asymptomatic patients must be<3% to ensure benefit for the patient. CAS should be reserved for symptomatic patients with stenosis of 50% to 99% at high risk for CEA for anatomic or medical reasons. CAS is not recommended for asymptomatic patients at this time. Asymptomatic patients at high risk for intervention or with <3 years life expectancy should be considered for medical management as the first-line therapy.

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Section: Anatomic and Lesion Characteristicsmentioning

confidence: 69%

Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease

Ricotta

AbuRahma

Ascher

et al. 2011

Journal of Vascular Surgery

558

536

View full text Add to dashboard Cite

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“…5,6,41,43,44 However, CEA contralateral to ICA occlusion is considered to have a higher surgical risk due to reduction of collateral flow during carotid clamping. 8,9 Routine or selective use of an intraluminal shunt during CEA has been reported to be effective for avoidance of this risk. 45,46 CAS also requires shorter temporary occlusion during the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] However, CEA for patients with contralateral ICA occlusion also has a high surgical risk. [7][8][9] The reported efficacy and safety of CAS for severe stenosis contralateral to a carotid occlusion suggest that CAS may be a therapeutic alternative in these patients. [10][11][12][13][14][15] In contrast to CEA, CAS is a relatively new technique and little is known about the hemodynamic consequences of contralateral CAS in patients with ICA occlusion.…”

mentioning

confidence: 99%

Cerebral Hemodynamic Benefits after Contralateral Carotid Artery Stenting in Patients with Internal Carotid Artery Occlusion

Oka

Ishihara

Kato

et al. 2012

AJNR Am J Neuroradiol

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SUMMARY:CEA contralateral to an ICA occlusion is considered a surgical risk, and CAS may be an alternative for these patients. Our goal was to examine whether CAS improves cerebral hemodynamics on the treated side and on the side of the ICA occlusion, on the basis of measurement of CBF and CVR by using SPECT. The subjects were 8 patients who underwent contralateral CAS. Resting CBF and CVR to acetazolamide were measured by using 123 I-IMP SPECT before and chronically (3-6 months) after CAS. Resting CBF was also measured immediately (Ͻ2 hours) after CAS by using 123 I-IMP SPECT. There were no significant differences in resting CBF in both hemispheres

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“…Thus, they concluded that in patients with CCO, the benefit of CEA was lost. A meta-analysis by Maatz et al 15) revealed that the perioperative stroke rate in patients with CCO was significantly greater than that in patients without CCO (3.7% vs. 2.4%, P = 0.002). There is some debate regarding the safety of CEA in patients with CCO although some authors have published shortterm studies on CEA with CCO that show no significant increase in complications in these patients.…”

Section: Discussionmentioning

confidence: 99%

Carotid Endarterectomy with Routine Shunt for Patients with Contralateral Carotid Occlusion

Kong

et al. 2017

ATCS

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Risk of Stroke for Carotid Endarterectomy Patients with Contralateral Carotid Occlusion

Cited by 43 publications

References 26 publications

Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease

Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease

Cerebral Hemodynamic Benefits after Contralateral Carotid Artery Stenting in Patients with Internal Carotid Artery Occlusion

Carotid Endarterectomy with Routine Shunt for Patients with Contralateral Carotid Occlusion

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