Safety of simultaneous bilateral internal carotid artery stenting
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Background
Stroke is a major global cause of death, affecting nearly 13.7 million people annually. Carotid artery stenosis accounts for up to 12% of all ischemic strokes. Bilateral carotid stenosis, which affects between 8 and 39% of patients with symptomatic carotid stenosis, presents a treatment challenge, as it is often a relative contraindication for carotid endarterectomy and is excluded from many clinical trials. With advancements in endovascular technology, simultaneous bilateral carotid angioplasty and stenting (SBCAS) has emerged as a safe and effective option, with complication risks similar to those of unilateral carotid artery stenting. The safety profile of SBCAS has been the subject of various studies, which have reported mixed outcomes.
Results
A total of 20 patients (14 males, 6 females) aged 51–75 years (mean: 63.95 ± 6.79 years) underwent SBCAS. Risk factors included smoking (50%), diabetes mellitus (55%), hypertension (90%), ischemic heart disease (30%), and dyslipidaemia (90%). The majority of patients (70%) presented with ischemic stroke, while 30% had TIA. Stenosis was predominantly in the proximal internal carotid artery, with significant stenosis (> 70%) observed in 50% of cases on the right and 70% on the left. All patients underwent successful SBCAS with a mean procedural time of 60.50 ± 7.76 min, utilizing a total of 40 stents (62.5% wall stents, 12.5% Protégé, and 25% CASPER). Procedural complications were minimal, with 40% experiencing transient hemodynamic depression and one case (5%) of hyper perfusion syndrome. No stroke, cardiac complications, vascular access issues, or mortality were recorded. Follow-up at 1 month showed stable NIHSS and mRS scores, with no new neurological deficits. Brain diffusion-weighted MRI was normal in 95% of patients.
Conclusion
SBCAS is a safe and effective procedure for properly selected patients with bilateral carotid stenosis and can help reduce the risk of recurrent cerebrovascular events.
