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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Emergency stenting to treat neurological complications occurring after carotid endarterectomy
A Anzuini1, C Briguori, G S Roubin
1Department of Cardiology, IRCCS San Raffaele Hospital, Milan, Italy.
Insights
Emergency stent implantation effectively treated perioperative stroke after carotid endarterectomy (CEA). This intervention showed superior results compared to surgical re-exploration, particularly for carotid dissection complications.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Carotid endarterectomy (CEA) effectively reduces stroke risk in patients with significant carotid artery stenosis.
- Perioperative stroke occurs in 1.5%–9% of CEA cases, posing a management challenge.
- Percutaneous transluminal carotid angioplasty with stenting is an emerging alternative for carotid artery disease.
Purpose of the Study:
- To evaluate the efficacy of emergency stent implantation for treating perioperative stroke following CEA.
- To compare stent implantation with surgical re-exploration for managing post-CEA stroke.
Main Methods:
- Eighteen of 995 patients (1.8%) experienced perioperative neurological complications after CEA.
- Thirteen patients underwent emergency carotid angiography and stent implantation.
- Five patients underwent surgical re-exploration.
Main Results:
- Carotid angiography identified dissection in five and thrombosis in eight patients.
- 100% angiographic success was achieved with direct stenting in all 13 treated patients.
- Complete symptom remission occurred in 11/13 (stent) vs. 1/5 (surgery) patients (p=0.024).
Conclusions:
- Emergency stent implantation is a safe and effective treatment for perioperative stroke after CEA.
- Stenting is particularly beneficial when carotid dissection is the primary cause of the complication.
Objectives:
The purpose of this study was to assess the efficacy of emergency stent implantation for the treatment of perioperative stroke after carotid endarterectomy (CEA).
Background:
Carotid endarterectomy has been proven safe and effective in reducing the risk of stroke in symptomatic and asymptomatic patients with >60% carotid artery stenosis. However, perioperative stroke has been reported in 1.5% to 9% of CEA cases. The management of such a complication is challenging. Recently, percutaneous transluminal carotid angioplasty with stent deployment has emerged as a valuable and alternative strategy for the treatment of carotid artery disease.
Methods:
Between April 1998 and February 2000, 18 of the 995 patients (1.8%) who had CEA in our institution experienced perioperative major or minor neurological complications. Of these, 13 patients underwent emergency carotid angiogram and eventual stent implantation, whereas the remaining five had surgery re-exploration.
Results:
Carotid angiogram was performed within 20+/-10 min and revealed vessel flow-limiting dissection (five cases) or thrombosis (eight cases). Percutaneous transluminal carotid angioplasty with direct stenting (self-expandable stent) was performed in all 13 cases. Angiographic success was 100%. Complete remission of neurological symptoms occurred in 11 of the 13 patients treated by stent implantation and in one of the five patients treated by surgical re-exploration (p = 0.024).
Conclusions:
Stent implantation seems to be a safe and effective strategy in the treatment of perioperative stroke complicating CEA, especially when carotid dissection represents the main anatomic problem.
