الفهرس 
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Abstract
Stroke is the main cause of long-term disability, and significant carotid stenosis is one of the main causes of ischemic stroke. It has been estimated that carotid artery stenosis may be responsible for 10% of ischemic strokes. In asymptomatic patients with 70-99% carotid artery stenosis, the ipsilateral stroke rate at 5 years is 14.6%, compared to 0% in patients with 50-70% stenosis, while patients with 80-99% carotid artery stenosis, the ipsilateral stroke rate is 18.3%, compared to 1% for patients with 50-80% stenosis. Asymptomatic Carotid Atherosclerosis study (ACAS) demonstrated aggregate risk reduction of 53% for carotid endarterectomy (CEA), compared to antiplatelet therapy alone in asymptomatic patients with > 60% carotid stenosis. On the other hand, symptomatic patients with > 50% carotid stenosis, the stroke risk are 26% at 2 years. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) demonstrate absolute risk reduction about 11.6-17% through CEA, compared to medical treatment in symptomatic patients.
Management of carotid artery stenosis is an effective and safe strategy for ischemic stroke prevention. CEA with optimal medical therapy is the first-line treatment of choice for low surgical risk patients with carotid artery stenosis. The intervention options for bilateral carotid artery stenosis (BCS) include bilateral CEA, unilateral CEA with contralateral CAS and bilateral CAS though there are risk factors for complications during CEA.
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.
Our study was a prospective analytical study carried on 20 Patients with bilateral extra-cranial internal carotid artery stenosis whether (symptomatic > 50) or (asymptomatic >70%). That was determined by duplex ultrasound and confirmed during the procedure with digital subtraction angiography. Measurement of the degree of stenosis was according to The North American Symptomatic Carotid Endarterectomy Trial (NASCET) methodology.
Patients underwent simultaneous bilateral carotid artery stenting (sBCAS) instead of staged bilateral carotid artery stenting.
In our study we found among those 20 patients as regard the mean time of the procedure, it 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, with 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 IC hge 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 in significant neurological deficit.
Finally, SBCAS is found to be a relatively safe and effective procedure for meticulous 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 symptoms 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.