Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET

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✓ The purpose of this study was to examine how the prognosis of patients who presented with a recent ischemic event referable to a 70% to 99% stenosis of one carotid artery (ipsilateral) was altered by stenosis and occlusion of the contralateral carotid artery. The benefit of performing carotid endarterectomy on the recently symptomatic artery, in the presence of contralateral artery disease, was also examined.

A total of 659 patients were grouped into one of three categories according to the extent of stenosis in the contralateral carotid artery: less than 70% (559 patients), 70% to 99% (57 patients), and occlusion (43 patients). Strokes that occurred during the follow-up period were designated as ipsilateral if they arose from the same carotid artery as the symptom for which the patient had been entered into the study. Medically treated patients with an occluded contralateral artery were more than twice as likely to have had an ipsilateral stroke at 2 years than patients with either severe (hazard ratio: 2.36; 95% confidence interval (CI): 1.00–5.62) or mild-to-moderate (hazard ratio: 2.65; 95% CI: 1.43–4.90) contralateral artery stenosis. The perioperative risk of stroke and death was higher in patients with an occluded contralateral artery (4.0% risk) or mild-to-moderate (5.1% risk) contralateral stenosis. Regression analyses indicated that the results were not affected by other risk factors.

An occluded contralateral carotid artery significantly increased the risk of stroke associated with a severely stenosed ipsilateral carotid artery. Despite higher perioperative morbidity in the presence of an occluded contralateral artery, the longer-term outlook for patients who had endarterectomy performed on the recently symptomatic, severely stenosed ipsilateral carotid artery was considerably better than for medically treated patients.

Article Information

Address for Dr. Gasecki: University of Nebraska Medical Center, Omaha, Nebraska.Address reprint requests to: Gary G. Ferguson, M.D., The John P. Robarts Research Institute, 100 Perth Drive, P. O. Box 5015, London, Ontario N6A 5K8, Canada.

© AANS, except where prohibited by US copyright law.

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Figures

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    Cumulative hazard curves showing risk (hazard rate) of ipsilateral stroke for medically treated patients at three degrees of contralateral carotid artery disease.

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    Cumulative hazard curves showing risk (hazard rate) of ipsilateral stroke for surgically treated patients at three degree of contralateral carotid artery disease.

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