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Contralateral High-Grade Carotid Artery Stenosis or Occlusion Is Not Associated with Increased Risk for Poor Neurologic Outcome after Elective Carotid Stent Placement¹

¹ From the Departments of Angiology (S.S., M.S., W.M., T.N., R.A., E.M.) and Clinical Neurology (W.L.), University of Vienna Medical School, Austria. Received October 24, 2002; revision requested January 7, 2003; final revision received May 20; accepted June 18. Address correspondence to S.S., Department of Internal Medicine II, Division of Angiology, Vienna General Hospital, Medical Faculty, Währinger Gürtel 18–20/6J, A-1090 Vienna, Austria (e-mail: schila.sabeti@akh-wien.ac.at).

PURPOSE: To compare neurologic outcome after elective internal carotid artery (ICA) stents have been placed in patients with and in patients without contralateral ICA obstructions.

MATERIALS AND METHODS: This study included 471 consecutive patients from a registry database who underwent elective ICA stent placement without cerebral protection for high-grade (greater than 70% stenosis of the ICA, according to the North American Symptomatic Carotid Endarterectomy Trial) symptomatic (n = 147) or asymptomatic (n = 324) ICA stenosis. Contralateral carotid arteries were investigated with angiography. Patients with and patients without contralateral high-grade stenosis (70%–99% stenosis, according to the North American Symptomatic Carotid Endarterectomy Trial) or occlusion were compared with respect to 30-day neurologic outcome by using the ² test and multivariate logistic regression analysis.

RESULTS: Neurologic events were observed in 33 patients (7%) with 15 transient ischemic attacks, eight minor strokes, and 10 major strokes that led to death in two patients (combined stroke and death rate, 4%). Eighty-eight patients (19%) with contralateral high-grade ICA stenosis and 43 patients (9%) with contralateral ICA occlusion exhibited a similar rate of postintervention combined neurologic events (n = 9, 7%) compared with patients without contralateral high-grade ICA stenosis or occlusion (n = 24, 7%) (P = .94). No differences were observed between symptomatic and asymptomatic patients. Combined stroke and death rates were also comparable between symptomatic (four of 131, 3%) and asymptomatic (14 of 340, 4%) patients (P = .59). Of all variables tested, multivariate analysis did not detect any predictor for peri- or postinterventional neurologic events.

CONCLUSION: Contralateral high-grade ICA stenosis or occlusion was not associated with an increased risk for neurologic events after elective ICA stent placement.

© RSNA, 2004

Index terms: Carotid arteries, interventional procedures, 172.1269 • Carotid arteries, stenosis or obstruction, 172.4311, 172.4312, 172.7213, 172.7214 • Stents and prostheses, 172.1269

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