Difficult clinical decisions regarding carotid artery revascularization in patients with contralateral carotid occlusion

Mathews, Robin Roy and Oláh, László and Csiba, László (2025) Difficult clinical decisions regarding carotid artery revascularization in patients with contralateral carotid occlusion. IDEGGYOGYASZATI SZEMLE / CLINICAL NEUROSCIENCE, 78 (3-4). pp. 100-106. ISSN 0019-1442

Text nehez-klinikai-dontesek-a-nyaki-veroer-revascularisatiojaval-kapcsolatban-kontralateralis-nyakiveroer-elzarodasban-szenvedo-betegeknel.pdf - Published Version Restricted to Repository staff only until 30 March 2026. Download (374kB) | Request a copy

Abstract

Background and purpose – Carotid revascularization through carotid endarterectomy (CEA) and carotid artery stenting (CAS)are well established secondary preventivemeasures after ischemic stroke in unilateralcarotid artery stenosis, but in the presenceof contralateral carotid occlusion (CCO) theevidence regarding the optimal managementof the stenotic carotid is not as clear eventhough the risk of ischemic stroke is high.The purpose of our review is to summarizerecent findings and suggest its future implications.Methods – We conducted a systematicliterature review using PubMed and ScienceDirect databases supplemented with studiesfound from Google Scholar.Results – Recent guidelines recommendCAS over CEA in patients with CCO, but incontrast some studies favor CEA over CAS after analysis of the complications and clinicaloutcome.Discussion – The decision between CEA andCAS depends upon a variety of factors suchas neurological status, surgical risk factors,medical comorbidities, age, and imagingfindings (presence of silent infarcts, plaquecharacteristics and the state of collateralcirculation). Due to the contradictory observations the authors suggest further multicenter studies to establish the optimal management of patients with carotid stenosisand CCO and also summarize their personalopinion.

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