Bilateral Internal Carotid Artery Stenosis: Risk Factors and Prognosis

Aim: Internal carotid artery stenosis may lead to ischemic events, temporary/permanent vision loss, and cognitive impairment. The aim of this study was to evaluate the association between risk factors for bilateral internal carotid artery stenosis (BICAS) and stroke, fundus findings, and cognitive impairment. Material and Methods: Patients who applied to the neurology outpatient clinic for any reason and were diagnosed with BIKAD by carotid doppler duplex ultrasonography and/or Computed Tomography Angiography were included in this study. Three groups were created for BICAS: (A) Severe stenosis in both arteries, (B) Severe stenosis in one artery and moderate stenosis in the other, and (C) Moderate stenosis in both arteries. Patients with a history of cerebral ischemic stroke or imaging findings were grouped as symptomatic, while others were asymptomatic. Those who were able to comply underwent fundus evaluation with an ophthalmoscope and mini-mental state examination (MMSE) by an experienced neurologist. The symptomatic group was also classified as those who received endovascular treatment and those who followed with the best medical treatment. Results: Eighty-six patients were evaluated. BICAS was higher in patients over 70 years and in males. In addition, patients in groups A and B had a higher risk of stroke. Cognitive impairment, ocular findings, and stenting rate were higher in group A. Conclusion: Cognitive impairment, ocular findings and stroke rates are higher in BICAS patients. Funduscopic examination and MMSE findings should be taken into consideration as non-invasive methods in the diagnosis of asymptomatic patients, and patients should be referred for further examination and treatment.