Revista de neurologia · 2007
[Contralateral occlusion: does it affect the therapeutic management of carotid stenosis?].
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Ponce-Cano A I, Reina-Gutierrez T, Martin-Conejero A, Morata-Barrado P C, Serrano-Hernando F J
Аннотация
INTRODUCTION: Because the contralateral carotid artery occlusion has been considered a high risk factor for ipsilateral carotid endarterectomy, some authors indicate a stenting procedure in these cases.
AIM: To evaluate whether there are different preoperative factors in patients with contralateral carotid occlusion and if the latter is associated to worse perioperative outcome.
PATIENTS AND METHODS: We analysed 476 carotid endarterectomies performed in 1994-2004. 57 cases (12.0%) had contralateral carotid occlusion. We analysed the results in patients with contralateral carotid occlusion and we compared them with the patients with contralateral patency. Prospective cohort study.
RESULTS: There were no differences in preoperative risk factors or comorbidity. Contralateral occlusion was associated to preoperative symptoms: 75.4-58.9%; OR: 1.2 (1.1-1.5); p = 0.02. The patients operated on under local anaesthesia who had contralateral occlusion and previous stroke, had a higher rate of cerebral ischaemia during carotid cross-clamping: 66.7-11.3%; RR: 5.8 (3.1-10.9); p = 0.002. Morbimortality was 2.3% in the global series and 0.0% in patients with contralateral carotid occlusion. Over 80-year-old patients with contralateral carotid occlusion had a higher global rate of cardiac complications: 28.6-0.0% (p = 0.01).
CONCLUSIONS: In our series, patients with contralateral carotid occlusion do not have a higher risk preoperative profile o higher perioperative morbimortality. Contralateral carotid occlusion does not justify, by itself, the endovascular treatment of an ipsilateral carotid stenosis.
AIM: To evaluate whether there are different preoperative factors in patients with contralateral carotid occlusion and if the latter is associated to worse perioperative outcome.
PATIENTS AND METHODS: We analysed 476 carotid endarterectomies performed in 1994-2004. 57 cases (12.0%) had contralateral carotid occlusion. We analysed the results in patients with contralateral carotid occlusion and we compared them with the patients with contralateral patency. Prospective cohort study.
RESULTS: There were no differences in preoperative risk factors or comorbidity. Contralateral occlusion was associated to preoperative symptoms: 75.4-58.9%; OR: 1.2 (1.1-1.5); p = 0.02. The patients operated on under local anaesthesia who had contralateral occlusion and previous stroke, had a higher rate of cerebral ischaemia during carotid cross-clamping: 66.7-11.3%; RR: 5.8 (3.1-10.9); p = 0.002. Morbimortality was 2.3% in the global series and 0.0% in patients with contralateral carotid occlusion. Over 80-year-old patients with contralateral carotid occlusion had a higher global rate of cardiac complications: 28.6-0.0% (p = 0.01).
CONCLUSIONS: In our series, patients with contralateral carotid occlusion do not have a higher risk preoperative profile o higher perioperative morbimortality. Contralateral carotid occlusion does not justify, by itself, the endovascular treatment of an ipsilateral carotid stenosis.