Contralateral Occluded Carotid Defines Revascularization Strategy

A significative lesion to the carotid artery in addition to contralateral carotid occlusion is an obvious factor of high risk for a revascularization procedure. However, this might be true for surgery but not for carotid artery stenting according to this recent publication in JACC.

Carótida ocluida contralateral define la estrategia de revascularización

The presence of contralateral carotid occlusion has been established as high risk for patients undergoing carotid endarterectomy, even though recent observational studies have cast a shadow on this paradigm. 

The aim of this study was to determine the clinical impact of contralateral occlusion in contemporary patients receiving endarterectomy or carotid artery stenting.  

All patients from a national registry receiving carotid revascularization presenting contralateral occlusion were included. 

Primary end point was a combination of death, stroke and MI.


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Of 58423 patients undergoing carotid revascularization, 7.9% (n=4624) had contralateral occlusion. Among these, 68.9% (n=3185) received surgery and 31.1% (n=1439) carotid artery stenting. Nearly half of patients (45.4%) presented with symptomatic disease because of prior stroke of transient ischemic attack. 

After multiple adjustments of different variables, researchers observed that a history of contralateral occlusion was associated with 71% increased events risk after endarterectomy (p<0.001), vs. no increased risk with carotid artery stenting (OR 0.94; CI 95%, p=0.64).

Conclusion

Contralateral carotid occlusion is an important risk factor for patients undergoing endarterectomy but no for patients receiving carotid artery stenting. This factor should be taken into account when deciding for or against a revascularization strategy. 

Original Title: Clinical Impact of Contralateral Carotid Occlusion in Patients Undergoing Carotid Artery Revascularization.

Reference: Anna K Krawisz et al. J Am Coll Cardiol. 2021 Feb 23;77(7):835-844. doi: 10.1016/j.jacc.2020.12.032.


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