Contralateral occlusion:: does it affect the therapeutic management of carotid stenosis?

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.