Treatment Strategy for Bilateral Severe Carotid Artery Stenosis: One Center's Experience

Liu, Bing; Wei, Wei; Wang, Yongli; Yang, Xinyu; Yue, Shuyuan; Zhang, Jianning

doi:10.1016/j.wneu.2015.03.067

Cited by 7 publications

(12 citation statements)

References 22 publications

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“…2,5 Bilateral carotid stenosis was observed in 51% of patients who underwent unilateral CAS, 17 and about 15% of patients who undergo unilateral surgical treatment subsequently need surgical treatment on the contralateral side. 12,17 Before the safety and effectiveness of CAS was established, bilateral CEA was enforced, 6,7 but it carries a risk of severe complications due to bilateral disorders of the phrenic pharyngeal nerve, vagus nerve, and/or stellate ganglion. 11 For this reason, recently BCAS or a combination of CEA and CAS has often been selected for bilateral carotid artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…11 For this reason, recently BCAS or a combination of CEA and CAS has often been selected for bilateral carotid artery stenosis. [8][9][10]12 Compared with a combination of CEA and CAS, BCAS is minimally invasive and involves a shorter interval between the procedures on each side. 10 When performing BCAS, treatment can be conducted in a simultaneous or staged manner.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Carotid artery stenting (CAS) is a useful surgical procedure for treating carotid artery stenosis, 3,4 and the number of patients with carotid artery stenosis that are being treated with CAS is increasing since it has been reported to be safe and effective. 2,5 Bilateral carotid endarterectomy (CEA), a combination of unilateral CEA and unilateral CAS, or bilateral CAS (BCAS) can all be used to treat bilateral carotid artery stenosis, [6][7][8][9][10][11][12] but bilateral CEA carries a risk of severe complications due to bilateral disorders of the phrenic pharyngeal nerve, vagus nerve, and/or stellate ganglion. 11 For this reason, BCAS or a combination of CEA and CAS has been often selected for bilateral carotid artery stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…11 For this reason, BCAS or a combination of CEA and CAS has been often selected for bilateral carotid artery stenosis. [8][9][10]12 BCAS can be performed in one (simultaneous BCAS) or two stages (staged BCAS). In comparison with staged BCAS, simultaneous BCAS might increase the risk of intra-or postoperative bradycardia and/or hypotension, due to bilateral baroreceptor stimulation 8,12,13 or hyperperfusion syndrome (HPS) resulting from an increase in bilateral intracranial blood flow.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10]12 BCAS can be performed in one (simultaneous BCAS) or two stages (staged BCAS). In comparison with staged BCAS, simultaneous BCAS might increase the risk of intra-or postoperative bradycardia and/or hypotension, due to bilateral baroreceptor stimulation 8,12,13 or hyperperfusion syndrome (HPS) resulting from an increase in bilateral intracranial blood flow. 9,12 On the other hand, simultaneous BCAS has the advantage of being less expensive and more convenient for patients than staged BCAS.…”

Section: Introductionmentioning

confidence: 99%

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Safety of simultaneous bilateral carotid artery stenting for bilateral carotid artery stenosis

et al. 2019

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Background Bilateral carotid artery stenting (BCAS) is often performed in two stages (staged BCAS) but it is also an option to be performed in one stage (simultaneous BCAS). To confirm the safety of simultaneous BCAS, we retrospectively analyzed perioperative and postoperative course of simultaneous BCAS compared with staged BCAS. Materials and methods Patients with symptomatic stenosis of ≥50% or asymptomatic stenosis of ≥80% of bilateral carotid arteries underwent BCAS. Procedure time, symptomatic ischemic complications, presence/absence of high-intensity spots on postoperative diffusion-weighted image, duration of postoperative hospital stays and 30 days outcome of patients performed with simultaneous BCAS (group A, 8 patients with 16 stenotic lesions (8 procedures)) were compared with those of staged BCAS (group B, 4 patients with 8 stenotic lesions (8 procedures)). Results In groups A and B, procedure time was 146.0 ± 53.8 and 103.5 ± 39.4 min; intraoperative hypotension was observed in 62.5% and 50.0%; postoperative hypotension occurred in 37.5% and 50.0%; diffusion-weighted image showed high-intensity spots in 37.5% and 12.5%; and duration of postoperative hospital stays was 5.1 ± 1.8 and 5.3 ± 2.3 days. No patients suffered symptomatic ischemic complications. In simultaneous BCAS, there was a tendency that procedure time was longer and high-intensity spots on postoperative diffusion-weighted image was more frequent, but there was no increase in symptomatic ischemic complications and duration of hospital stays compared to staged BCAS. Conclusions Safety of simultaneous BCAS may not be inferior to staged BCAS. In terms of duration of hospital stays, simultaneous BCAS can be superior to staged BCAS for patients with bilateral carotid artery stenosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety of simultaneous bilateral carotid artery stenting for bilateral carotid artery stenosis

et al. 2019

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Study on the correlation between the circle of Willis structure and collateral circulation in bilateral carotid artery occlusion

Liu

Zhu²,

Hou³

et al. 2021

Neurol Sci

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Background and purpose Bilateral carotid artery occlusion (CAO) is a rare condition and the collateral circulation is more complicated than in unilateral CAO. The circle of Willis (CoW) is the most important collateral circulation compensation pathway in CAO. However, the specific role of CoW in the collateral circulation compensation pathway of CAO has not been fully elucidated. The purpose of this study is to investigate the role of CoW in the collateral circulation compensation pathway of CAO. Materials and methods Clinical, imaging, and hemodynamic data of 30 patients with bilateral CAO were collected to analyze the collateral blood flow compensation pathway and its characteristics, and to examine the correlation between the structure of the CoW and the collateral circulation of bilateral CAO. Results This paper summarized 30 patients with bilateral CAO. There were 0 cases of the CoW complete type, 18 cases of the partially complete type (60%), and 12 cases of the incomplete type (40%). For the partially complete type cases, there were 14 complete anterior circulation cases (46.7%). The collateral circulation collateral circulation pathway included 14 cases with anterior communicating artery(ACoA), 7 cases with posterior cerebral artery (PCA)-middle cerebral artery (MCA) leptomeningeal anastomosis (LMA), 5 cases with ophthalmic artery(OA), 3 cases with lateral posterior communicating artery(PCoA), 1 case with internal carotid artery (ICA) stealing, 1 case with new Moyamoya vessels, and 4 cases of other types. There were four cases (13.3%) with complete posterior circulation, including four cases with bilateral PCoA, three cases with PCA-MCA LMA, and two cases with OA. There were 12 cases (40%) with incomplete CoW, including 8 cases with PCA-MCA LMA, 3 cases with lateral PCoA, 1 case with anterior cerebral artery (ACA)-MCA LMA, 4 cases with OA, and 1 other case. Conclusion The collateral circulation pathway differs among patients with different CoW structure types. When the CoW is partially complete, it mainly provides blood flow compensation to the ischemic area through primary collateral circulation. When the CoW is incomplete, it mainly provides blood flow compensation to the ischemic area through secondary collateral circulation.

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A systematic review and meta-analysis of results of simultaneous bilateral carotid artery stenting

Lai

Shao

Chen

et al. 2019

Journal of Vascular Surgery

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Treatment Strategy for Bilateral Severe Carotid Artery Stenosis: One Center's Experience

Cited by 7 publications

References 22 publications

Safety of simultaneous bilateral carotid artery stenting for bilateral carotid artery stenosis

Safety of simultaneous bilateral carotid artery stenting for bilateral carotid artery stenosis

Study on the correlation between the circle of Willis structure and collateral circulation in bilateral carotid artery occlusion

A systematic review and meta-analysis of results of simultaneous bilateral carotid artery stenting

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