Feasibility of Simultaneous Bilateral Carotid Stenosis—A Single Center Series of Four Cases

Introduction: Carotid stenosis comprises 20% of ischemic stroke with 8 to 39% prevalence bilaterally in cases undergoing revascularization procedure. Bilateral carotid stenting is effective in high-risk cases with staged procedure. We aim to address the feasibility of simultaneous bilateral carotid stenting (SBCS).

Method(s): Prospective data noted in 4 cases planned for SBCS in 1 year. Digital subtraction angiogram confirmed stenosis (NASCET criteria) with >50% symptomatic or >60% asymptomatic stenosis were selected. Risk factors, clinical, periprocedural events, and follow-up noted. Femoral access with local anesthesia in all and embolic protection device used in 3 cases. Stents used were 8 × 6, 40 mm (Xact/Acculink) with 2 undergoing prior balloon angioplasty (4 × 20 mm). All received dual antiplatelets, 24-hour CT, and ICU monitoring.

Result(s): Cases include males (65–75 years) with at least 1 risk factor. Two had hemispheric stroke and underwent angioplasty + stenting with no adverse event. Two asymptomatic cases had TVD-1 developed brief bradycardia reversed by atropine; other pulmonary edema post-single stent. None had hyperperfusion/stroke at discharge.

Conclusion(s): SBCA is feasible and relatively safe in high-risk cases. Acceptable risks involved can be avoided with fluid management and intensive vital monitoring. Larger studies are needed for validation.

Publication History

Article published online:
09 February 2023