Outcome evaluation of carotid stenting in high-risk patients with symptomatic carotid near occlusion
1Department of Radiology and Research Institute of Radiology, University of Ulsan, Seoul, Korea.
Insights
Carotid stenting in high-risk patients with near occlusion showed good outcomes, similar to standard carotid artery stenting (CAS). Initial stroke severity (NIHSS) predicted poor outcomes, with hyperperfusion being a common complication.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Management of symptomatic carotid near occlusion in high-risk patients requires specific outcome analysis.
- Existing data from trials like NASCET may not fully represent outcomes in this high-risk subgroup.
Purpose of the Study:
- To evaluate the outcomes of carotid stenting in high-risk patients with symptomatic near occlusion.
- To compare these outcomes with patients undergoing carotid artery stenting (CAS) for symptomatic stenosis without near occlusion.
Main Methods:
- Retrospective analysis of 48 high-risk patients with symptomatic near occlusion undergoing carotid stenting.
- Assessment of procedural success (residual stenosis <30%), modified Rankin Scale (mRS) at 1 and 6 months.
- Comparison with 118 patients who underwent CAS for symptomatic stenosis without near occlusion.
Main Results:
- Procedural success rate was 98% with 92% achieving a good outcome (mRS ≤2) at six months.
- Five events (10%) occurred within six months: 3 minor strokes, 1 major stroke (hemorrhagic), and 1 death.
- Hyperperfusion was the most common cause of post-stenting events. Initial NIHSS (≥4) was significantly related to poor outcomes (P = .012).
Conclusions:
- Carotid stenting in high-risk patients with symptomatic near occlusion yields outcomes comparable to standard CAS.
- Initial stroke severity (NIHSS) is a key predictor of poor outcomes.
- Hyperperfusion is a notable complication post-stenting in this patient group.
Abstract:
Management of symptomatic carotid near occlusion especially in high-risk patients is different from outcome analysis of NASCET. We evaluated outcome in high-risk patients with symptomatic near occlusion. For 48 patients with near occlusion out of 166 symptomatic high-risk patients who underwent carotid stenting, we assessed the procedural success defined as residual stenosis <30%, modified Rankin Scale (mRS) at one and six months following stenting, and the 13 cerebrovascular factors related to the outcome. Initial National Institutes of Health Stroke Scale (NIHSS) ≥4, 1-3 and 0 were 13, 14 and 21 patients each. We compared the outcome with patients who underwent CAS (n=118) due to symptomatic stenosis without near occlusion during the same period. Our procedural success rate was 98%. A good outcome (mRS ≤2) was achieved in 44 patients (92%) at six months. There were five events (10%) within six months, i.e. three minor strokes, one major stroke caused by hemorrhage, and one death excluding two deaths not related to stroke. Hyperperfusion (n=4) was the most common cause of events leading to two minor strokes and a major stroke. Although initial NIHSS (P = .012) was related to poor outcome (mRS >2) compared to the CAS group, there was no statistical significance between two groups in the event rate of stroke, death or restenosis. The outcome of carotid stenting in high-risk patients with symptomatic near occlusion did not reveal any difference compared with CAS. Poor outcome was related to the initial NIHSS (≥4). Hyperperfusion tended to be more commonly related to an event occurring after stenting.
