Safety of Simultaneous Bilateral Internal Carotid Artery Stenting
Authors: Amin Aref Hany Mohammed Mohamed , Al-Bassiouny Ahmed Ali Ibrahim , Afify Hosam El-dein Mahmoud , El-Sudany Ayman Hassan Othman , Kenawy Fatma Fathalla Mahmoud , Mohammed Sherif Ahmed Salah 
Published: November 2024

Abstract

Background
Stroke is a leading cause of death worldwide, with a prevalence of nearly 13.7 million people every year. Approximately 80% of strokes are ischemic, and although the prevalence is growing among cerebrovascular diseases, its mortality and morbidity decreased during the last decade. Carotid artery stenosis is responsible for up to 12% of all ischemic strokes.

Aim of the Work
Our study Aim was to assess the safety and efficacy of simultaneous bilateral internal carotid artery stenting in patients with bilateral extra-cranial internal carotid artery stenosis.

Patients and Methods
Our study is a prospective analytical study carried on 20 Patients with bilateral extra- cranial internal carotid artery stenosis whether (symptomatic &gt; 50) or (asymptomatic &gt;70%). That was determined by duplex ultrasound and confirmed during the procedure with digital subtraction angiography.

Results
In our study we found among those 20 patients the mean time of the procedure was (in minutes) 60.50 ± 7.76 also 8 of them (40.0%) had hemodynamic depression which required medical treatment intra procedural with no prolonged reported cases for HD post procedural, none of them (0.0%) had Vascular access complications and post-operative hospital stays ranged from 2-3 days in all patients yet most of them was discharged in the post-procedural day. Among those 20 patients, only one patient 1 (5.0%) had post procedural complication in the form of hyperperfusion syndrome which manifested as headache and seizures (behavioural arrest and focal colonic seizures) which lasted shortly and was self limited with no evidence of IChge on CT brain. No one had post procedural stroke, cardiac, renal complications and no mortality happened. Regarding MRS and NIHSS post procedural there were no progression or change in comparison with these scaled pre procedural. All 20 patients underwent MRI brain especially post procedural with especial attention to Diffusion weighted image sequence (DWI), among them 19 patients (95 %) had no abnormalities while only 1 patient (5%) had few new restricted spots in DWI without any significant neurological deficit.

Conclusion
SbCAS is found to be a relatively safe and effective procedure for meticuslouy selected patients with bilateral carotid stenosis and can decrease the risk of repeated cerebrovascular events. Therefore, patients with bilateral carotid stenosis should be carefully examined, and the best treatment strategy should be evaluated using a multidisciplinary approach considering the possibility of sbCAS. Although the rate of HPS was higher than that of unilateral CAS, the absolute number of patients who suffered HPS remained small and was suffering from mild sympotoms that spontaneously resolved. Except for HPS, all other periprocedural complications including HD, stroke, MI, and their combinations were non inferior in comparison to those given in the literature reporting unilateral cases.