Management of Bilateral Carotid Occlusive Disease

Authors

Ashutosh P. Jadhav, Departments of Neurology and Neurosurgery, UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA.Follow
Andrew F. Ducruet, Departments of Neurology and Neurosurgery, UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA.Follow
Brian T. Jankowitz, Departments of Neurology and Neurosurgery, UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA.
Tudor G. Jovin, Departments of Neurology and Neurosurgery, UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA.

Document Type

Article

Abstract

BACKGROUND: Symptomatic bilateral internal carotid occlusive disease is a rare but potentially devastating entity. Medical therapy alone is associated with high rates of mortality and recurrent stroke. The optimal management of this disease remains poorly understood. METHODS: A retrospective review of a prospectively maintained database was conducted for patients who presented with an acute stroke in the setting of bilateral carotid occlusive disease between May and October 2013. RESULTS: We identified 3 patients. The admission National Institutes of Health Stroke Scale score ranged from 4 to 7. All patients had small- to moderate-sized infarcts in the anterior circulation on presentation. Angiography confirmed bilateral internal carotid occlusions with collateral filling via the posterior communicating artery and retrograde filling via external carotid artery supply to the ophthalmic artery. All patients were initially managed with permissive hypertension and anticoagulation followed by carotid angioplasty and stenting. At 1-year follow-up, all patients demonstrated a modified Rankin scale score of 0-1. CONCLUSIONS: Carotid stenting may be a safe and effective therapy for patients presenting with symptomatic bilateral carotid occlusions.

Keywords

Acute stroke, Carotid occlusion, Intervention, Revascularization

Publication Date

3-1-2016

Publication Title

Interventional neurology

ISSN

1664-9737

Volume

4

Issue

3-4

First Page

96

Last Page

103

PubMed ID

27051405

Digital Object Identifier (DOI)

10.1159/000442530

Recommended Citation

Jadhav, Ashutosh P.; Ducruet, Andrew F.; Jankowitz, Brian T.; and Jovin, Tudor G., "Management of Bilateral Carotid Occlusive Disease" (2016). Translational Neuroscience. 2126.
https://scholar.barrowneuro.org/neurobiology/2126