Treatment Strategy for Bilateral Severe Carotid Artery Stenosis: One Center's Experience.

Objective: To describe 1 center's experience using carotid artery stenting (CAS) or carotid endarterectomy (CEA) as a treatment strategy in patients with bilateral carotid artery stenosis.

Methods: Patients with severe carotid artery stenosis, including bilateral carotid artery stenosis, treated by CEA or CAS during the period 2008-2013 were reviewed retrospectively. The selection of treatment depended on the individual patient's medical comorbidities, neurologic condition, and clinical and anatomic arterial factors. The main adverse events included death from any cause, major stroke within 30 days, and death between 30 days and 1 year later from the treated carotid artery or ipsilateral major stroke.

Results: There were 27 patients with bilateral carotid artery stenosis treated, including 11 patients with bilateral CEA, 9 patients with CEA on one side and CAS on the other side, and 7 patients with bilateral CAS. Of patients with unilateral carotid artery stenosis, 69 were treated with CEA, and 75 were treated with CAS. The incidence of main adverse events for the bilateral patients was 7.4%, similar to the unilateral patients undergoing CEA and CAS (8.7% and 6.7%, respectively). Restenosis occurred in 4 treated carotid arteries in bilateral patients within 1 year (4 of 54 [7.4%]); this was not significantly different from unilateral patients undergoing CEA and CAS (4 of 69 [5.8%] and 6 of 75 [8.0%], respectively). Local complications were not more frequent in bilateral patients.

Conclusions: Good outcomes can be achieved in patients with bilateral carotid artery stenosis when treatment selection is based on each individual patient's clinical characteristics and with a proper combination of staged CEA and CAS.