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Carotid artery stenting in recently symptomatic patients: a single center experience
Carlo Setacci1, Gianmarco de Donato, Emiliano Chisci
1Department of Surgery, Vascular and Endovascular Surgery Unit, University of Siena, 53100 Siena, Italy. setacci@unisi.it
Insights
Early carotid stenting (CAS) is safe and feasible for patients with recent transient ischemic attack (TIA) or minor stroke. This approach shows satisfactory outcomes in high-risk individuals, improving or stabilizing neurological deficits.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Management of acute symptoms from carotid stenosis is debated.
- Predicting early recurrent stroke risk after TIA or stroke is challenging.
- Variations in acute stroke management exist between physicians and institutions.
Purpose of the Study:
- To evaluate clinical outcomes of symptomatic carotid stenosis patients.
- To assess urgent versus deferred carotid artery stenting (CAS).
- To analyze outcomes based on a pre-identified protocol.
Main Methods:
- 43 patients with >70% symptomatic carotid stenosis underwent CAS (Jan 2006-Oct 2008).
- Exclusion criteria: major stroke, large ischemic lesion, loss of consciousness, intracranial hemorrhage.
- Urgent CAS for TIA (within 24h), deferred CAS for minor stroke (1-30 days).
Main Results:
- 100% successful stent implantation using cerebral protection devices.
- TIA group (1 month): 3.8% non-neurological death, 3.8% TIA.
- Minor stroke group (1 month): 58.8% improved neurological deficit, 35.3% stable deficit.
Conclusions:
- Early protected CAS is feasible and safe for selected TIA or minor stroke patients.
- Urgent endovascular approach shows satisfactory outcomes in high-risk populations.
- This preliminary study supports early intervention for symptomatic carotid stenosis.
Background:
The effective and early management of patients with acute symptoms due to carotid stenosis remains the subject of debate. The inability to predict who is at higher early risk of a recurrent stroke after a cerebrovascular event (transient ischemic attack [TIA] or stroke) may explain the variation in management of acute strokes from physician to physician and institution to institution. The aim of this study is to evaluate the clinical outcome of recently symptomatic patients with carotid stenosis treated with urgent or deferred carotid artery stenting (CAS) on the basis of a preidentified protocol in a single center.
Methods:
From January 2006 to October 2008, 43 patients with symptomatic carotid stenosis greater than 70% underwent urgent or deferred CAS (26 TIA, 17 minor stroke). The exclusion criteria were major stroke, cerebral ischemic lesion greater than 2.5 cm as documented by a computed tomography scan, loss of consciousness, and signs of intracranial hemorrhage. Patients who had a TIA underwent urgent CAS within 24 hours of the cerebral event, while patients who had had a minor stroke underwent deferred CAS, performed within a short space of time from the event (treatment within 1 to 30 days from the onset of symptoms, according to the stabilization of cerebral symptoms: mean time, 6.5 days; range, 2 to 28 days).
Results:
Successful stent implantation was achieved in all cases (100%), respecting the use of a cerebral protection device (filter device: 76%, proximal occlusion device: 24%). The new adverse events in the TIA patients at 1 month were 1 non-neurological death (3.8%) and 1 TIA (3.8%). In the minor stroke group, at 1 month, 10 of 17 patients (58.8%) experienced an improvement in their initial neurological deficit (decrease in National Institutes of Health Stroke Scale less than 2), while in 35.3% of patients (6 of 17), the deficit remained stable, and only one patient had a neurological impairment.
Conclusion:
Our study demonstrated that early treatment with protected carotid stenting is both feasible and safe in selected patients with first episode or recurrent TIA or minor stroke. This preliminary study in a limited series of patients revealed that an urgent endovascular approach is associated with a satisfactory outcome considering the very high-risk profile of the patient population.
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