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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Emergency carotid artery stent placement in patients with acute ischemic stroke
Keisuke Imai1, Takahisa Mori, Hajime Izumoto
1Department of Stroke Treatment, Shonan Kamakura General Hospital, Kamakura, Japan.
Insights
Emergency carotid artery stent placement significantly improved neurologic symptoms in acute ischemic stroke patients. This intervention shows promise for improving clinical outcomes in carefully selected individuals.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Acute ischemic stroke with internal carotid artery (ICA) occlusion or high-grade stenosis lacks established effective interventions.
- Current treatment options for severe neurologic symptoms due to ICA stenosis remain limited.
Purpose of the Study:
- To evaluate the feasibility, safety, and efficacy of emergency carotid artery stent placement.
- To assess the impact of stenting on neurologic symptoms and clinical outcomes in stroke patients.
Main Methods:
- Retrospective review of 17 patients with acute ischemic stroke undergoing emergency carotid artery stent placement.
- Assessment of neurologic outcome using National Institutes of Health Stroke Scale (NIHSS) scores.
- Evaluation of clinical outcome with modified Rankin Scale (mRS) scores at 90 days.
- Monitoring for procedure-related complications and ipsilateral ischemic stroke recurrence.
Main Results:
- Complete dilation of carotid lesions was achieved in all patients.
- Significant improvement in median NIHSS scores from 12 to 5 at 7 days post-procedure (P < .01).
- 59% of patients achieved favorable clinical outcomes (mRS 0-1) at 90 days.
- Two patients (12%) experienced irreversible complications (distal embolism, intracerebral hemorrhage); no stroke recurrence was observed.
Conclusions:
- Emergency carotid artery stent placement is a feasible and safe option for selected acute ischemic stroke patients.
- The procedure demonstrates significant improvement in short-term neurologic function.
- Stenting may lead to improved long-term clinical outcomes in patients with ICA stenosis.
Background And Purpose:
An effective intervention has not yet been established for patients with acute ischemic stroke who present with serious neurologic symptoms due to occlusion or a high-grade stenosis of the internal carotid artery (ICA). The aim of our retrospective study was to investigate the feasibility, safety, and efficacy of emergency carotid artery stent placement to improve neurologic symptoms and clinical outcome.
Methods:
Of 896 consecutive patients with acute ischemic stroke who were admitted to our institution within 7 days of onset from July 2000 to June 2003, 17 patients (1.9%) with occlusion or a high-grade stenosis of the ICA underwent emergency carotid artery stent placement. We reviewed their records for neurologic outcome, per the National Institutes of Health Stroke Scale (NIHSS) score, before and at 7 days after stent placement; clinical outcome, per the modified Rankin Scale score (mRS), at 90 days; frequency of procedure-related complications within 30 days; and recurrence rate of ipsilateral ischemic stroke within 90 days.
Results:
Carotid lesions were dilated completely in all patients. Median NIHSS scores before emergency stent placement and at 7 days were 12 and 5, respectively, showing significant improvement (P < .01, Wilcoxon rank sum test). Ten patients (59%) had favorable outcomes (mRS score 0-1) at 90 days. Irreversible complications occurred in two patients (12%): distal embolism in one and intracerebral hemorrhage in the other. No ipsilateral ischemic stroke recurred.
Conclusion:
Emergency carotid artery stent placement can improve the 7-day neurologic outcome and may improve the 90-day clinical outcome in selected patients with ischemic stroke.
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