Carotid artery stenting of a contralateral occlusion and in-hospital outcomes: results from the CARE (Carotid Artery Revascularization and Endarterectomy) registry

JACC Cardiovasc Interv. 2013 Jan;6(1):59-64. doi: 10.1016/j.jcin.2012.09.009.


Objectives: The authors sought to study the characteristics and outcomes of patients with contralateral carotid artery occlusions (CCOs) undergoing elective carotid artery stenting (CAS).

Background: CCOs are associated with adverse neurological events following carotid endarterectomy.

Methods: In-hospital outcomes were examined in patients with and without CCO undergoing elective CAS in the Carotid Artery Revascularization and Endarterectomy (CARE) registry. A CCO was defined as a 100% occlusion of the contralateral internal carotid artery. To minimize differences in measured comorbidities, a 3:1 propensity matching analysis was performed comparing 42 clinical and demographic variables between CCO and non-CCO patients from the CARE registry. The primary endpoint was a composite of in-hospital death, nonfatal myocardial infarction, and nonfatal stroke.

Results: Between April 2005 and January 2012, 13,993 eligible patients underwent elective CAS, of whom 1,450 (10%) had CCO. There were 5,500 CAS procedures (1,375 CCO and 4,125 non-CCO) identified in the propensity analysis. The primary composite endpoint occurred in 29 (2.1%) and 107 (2.6%) patients with and without CCO, respectively (adjusted odds ratio: 0.81, 95% confidence interval: 0.53 to 1.23, p = 0.316).

Conclusions: In the CARE registry, there was no evidence that the presence of a CCO was associated with an increased risk of in-hospital death, nonfatal myocardial infarction, or nonfatal stroke in patients undergoing elective CAS. These findings may have implications on the selection of carotid revascularization procedures for such patients.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angioplasty / adverse effects
  • Angioplasty / instrumentation*
  • Angioplasty / mortality
  • Carotid Stenosis / complications
  • Carotid Stenosis / mortality
  • Carotid Stenosis / surgery
  • Carotid Stenosis / therapy*
  • Endarterectomy, Carotid* / adverse effects
  • Endarterectomy, Carotid* / mortality
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Odds Ratio
  • Patient Selection
  • Propensity Score
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Stents*
  • Stroke / etiology
  • Time Factors
  • Treatment Outcome
  • United States