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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Severe bilateral carotid stenosis

The impact of ipsilateral stenting on Doppler-defined contralateral stenosis

Ravish Sachar, MD^*, Jay S. Yadav, MD^*,*, Marco Roffi, MD, Leslie Cho, MD, Joel P. Reginelli, MD^*, Alex Aböu-Chebl, MD^*, Deepak L. Bhatt, MD^* and Christopher T. Bajzer, MD^*

^* Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Division of Cardiology, University Hospital, Zurich, Switzerland
Division of Cardiology, Loyola University Health System, Maywood, Illinois, USA

Manuscript received May 2, 2003; revised manuscript received November 13, 2003, accepted November 17, 2003.

^* Reprint requests and correspondence: Dr. Jay S. Yadav, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, USA 44195.
yadavj{at}ccf.org

OBJECTIVES: The study examined the effect of carotid stenting (CS) on contralateral carotid Doppler-defined degree of stenosis.

BACKGROUND: Patients with carotid disease are frequently referred for carotid revascularization (carotid endarterectomy [CEA] or CS) based on the results of carotid duplex studies. Although a drop in flow velocities in the contralateral carotid has been described after CEA, the effect of ipsilateral stenting on contralateral velocities has not been defined.

METHODS: A total of 104 consecutive patients underwent CS and were divided into two cohorts, those with unilateral stenosis, and those with bilateral stenosis. Doppler-defined pre-procedural peak systolic velocities (PSV) and end-diastolic velocities (EDV) in the contralateral carotid were compared with the post-procedural velocities. Post-procedural angiographic stenoses were compared with post-procedural duplex-defined stenoses.

RESULTS: Among patients with bilateral stenosis, after ipsilateral stenting there was a drop in the contralateral PSV and EDV of 60.3 cm/s (p = 0.005) and 15.1 cm/s (p = 0.03), respectively. There was no change in the contralateral velocities in patients with unilateral stenosis. Among patients with 60% stenosis by duplex in the contralateral carotid, 20% dropped to a lower classification of contralateral stenosis after ipsilateral stenting. Furthermore, 71% of patients with significant contralateral stenosis by duplex pre-stenting did not have significant stenosis by angiography.

CONCLUSIONS: Patients with bilateral carotid disease may have elevated Doppler flow velocities in the contralateral carotid resulting in an artifactually high grade of stenosis. After ipsilateral carotid revascularization, such patients should have a repeat Doppler of the contralateral carotid to assess the true grade of stenosis.

Abbreviations and Acronyms   CAD = coronary artery disease   CEA = carotid endarterectomy   CVA = cerebrovascular accident   DM = diabetes mellitus   EDV = end-diastolic velocity   LV = left ventricular   MRA = magnetic resonance angiography   PSV = peak systolic velocity   PVD = peripheral vascular disease   QCA = quantitative carotid angiography   TIA = transient ischemic attack

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