Management of carotid stenosis in patients with a contralateral carotid occlusion

There are currently no universal recommendations for the treatment of carotid stenosis in patients who have a contralateral occlusion or tandem lesions. Treatment options include carotid stenting and endarterectomy. We herein present two patients who received individualized treatment for carotid stenosis at our hospital. Both experienced ischemic symptoms as a result of the additional presence of contralateral carotid occlusion. An extracranial-intracranial (EC-IC) bypass was initially performed on the side contralateral to the stenosis. After cerebral blood flow (CBF) and blood reservation recovered on that side, carotid endarterectomy or PTA/stenting was performed to treat the carotid stenosis on the opposite side. Both patients responded well to treatment. Thus, it is important that information concerning a patient's specific hemodynamic situation be considered when formulating treatment options for carotid stenosis patients.