Single Center Experience on Endovascular Treatment of Occlusion and/or Stenosis of Bilateral Carotid Arteries

TL;DR

This study examines the safety and effectiveness of endovascular treatment for patients with narrowing or blockage in both carotid arteries, showing it can be a viable option in specialized stroke centers.

Contribution

The study provides real-world clinical outcomes of carotid artery stenting for bilateral carotid artery stenosis or occlusion in a comprehensive stroke center.

Findings

Endovascular treatment was associated with manageable complication rates in patients with bilateral carotid artery issues.

Major strokes were effectively treated with mechanical thrombectomy in this patient group.

Most patients were symptomatic, with hypertension being the most common comorbidity.

Abstract

Carotid artery stenosis is the presence of 50% or more stenosis in the internal carotid artery (ICA) according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria and is one of the leading etiological factors of ischemic stroke. The severity of stenosis is associated with stroke risk. The prevalence of bilateral carotid artery stenosis (BCAS) varies. This study aims to evaluate the clinical outcomes and complications associated with carotid artery stenting in patients with BCAS or occlusion in a comprehensive stroke center.

The data of patients who underwent carotid artery stenting (CAS) between January 2020 and September 2024 were scanned. The demographic data and comorbidities were noted from the patients’ files. Then, the patients were divided into two groups. The first group is “bilateral 50%–99% ICA stenosis” and the second group is “one side ICA occluded contralateral side ICA ≥50% stenosis”. Both groups were also listed as symptomatic and asymptomatic. Demographic and endovascular procedure data were analyzed.

A total of 82 patients were included in this study, 69 male (84.14%) and 13 female (15.85%). The mean age was 69.46 ± 7.24. Hypertension (HT) was the most common comorbid disease (69.51%). Sixty‐six patients (80.50%) were symptomatic and 16 (19.50%) were asymptomatic. TIA developed in one patient in the first group. Two minor (The National Institutes of Health Stroke Scale [NIHSS] 1–3) and two major strokes developed in the second group. Only three patients (two in the first group, one in the second group) underwent postdilatation balloon angioplasty.

Endovascular treatment seems to be an acceptable strategy in comprehensive stroke centers where the possible complication risks can be well managed in this group of patients.

This study investigates the role of carotid artery stenting (CAS) in the treatment of bilateral carotid artery stenosis and/or occlusion. Although transient ischemic attacks (1.22%) and minor strokes (2.44%) were observed, major strokes (2.44%) were effectively treated with mechanical thrombectomy. These results demonstrate that endovascular treatment is a safe and effective strategy for the treatment of bilateral carotid lesions in high‐risk patients, with complications well managed in a comprehensive stroke center setting. However, future randomized trials are needed to define optimal treatment protocols and improve patient outcomes.

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