To examine the association between a contralateral carotid artery occlusion (CCO) and the rates of subsequent target‐lesion restenosis and revascularization after carotid artery stenting (CAS).

Patients with carotid artery disease undergoing revascularization often have a CCO. The association of a CCO with long‐term outcomes after CAS is uncertain.

At two institutions, 267 CAS procedures were performed from 2006 to 2016 including 47 (18%) with a CCO. Regular follow‐up with duplex carotid ultrasound was performed to assess for restenosis. Univariate Cox regression analysis was performed to evaluate the association between the presence of a CCO and repeat revascularization.

The mean patient age was 70 years. There was no significant difference (P > 0.05) in procedural indication (asymptomatic vs ischemic symptoms) or medical comorbidities between groups. During 5‐year follow up, the rate of duplex‐derived >80% stenosis was 6% in the non‐CCO group and 9% in the CCO group (P = 0.45). Despite similar rates of >80% restenosis, there was a significant association between CCO and subsequent target‐lesion revascularization (TLR), with rates of 6.4% vs 0.9% at 5 years (HR 7.2, confidence interval (CI) 1.2–43, P = 0.04). There were no significant differences between groups in the 5‐year rates of stroke (4.3% in CCO group vs 4.5% in non‐CCO group, HR 0.53, CI 0.07–4.22, P = 1.0) or MACCE (15% vs 18%, HR 0.55, CI 0.2–1.55, P = 0.68).

Patients undergoing CAS with a CCO were more likely to undergo TLR during long‐term follow up, but they did not have any differences in procedural success or short‐ and long‐term outcomes.