Difficult clinical decisions regarding carotid artery revascularization in patients with contralateral carotid occlusion.

Background and purpose - Carotid revascularization through carotid endarterectomy (CEA) and carotid artery stenting (CAS) are well established secondary preventive measures after ischemic stroke in unilateral carotid artery stenosis, but in the presence of contralateral carotid occlusion (CCO) the evidence regarding the optimal management of the stenotic carotid is not as clear even though the risk of ischemic stroke is high. The purpose of our review is to summarize recent findings and suggest its future implications. Methods - We conducted a systematic literature review using PubMed and ScienceDirect databases supplemented with studies found from Google Scholar. Results - Recent guidelines recommend CAS over CEA in patients with CCO, but in contrast some studies favor CEA over CAS after analysis of the complications and clinical outcome. Discussion - The decision between CEA and CAS depends upon a variety of factors such as neurological status, surgical risk factors, medical comorbidities, age, and imaging findings (presence of silent infarcts, plaque characteristics and the state of collateral circulation). Due to the contradictory observations the authors suggest further multicenter studies to establish the optimal management of patients with carotid stenosis and CCO and also summarize their personal opinion.