Effect of stenting on patients with chronic internal carotid artery occlusion
1Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, Republic of China.
Insights
Carotid artery stenting (CAS) improved functional outcomes for chronic internal carotid artery occlusion patients compared to medical therapy. However, CAS did not significantly reduce cerebrovascular events or mortality, necessitating further research.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Interventional Cardiology
Background:
- Chronic internal carotid artery occlusion poses a significant risk for cerebrovascular events.
- The efficacy of carotid artery stenting (CAS) in managing this condition remains unclear.
- Optimal medical therapy serves as a benchmark for treatment comparison.
Purpose of the Study:
- To evaluate the effects of carotid artery stenting (CAS) versus optimal medical therapy in patients with chronic internal carotid artery occlusion.
- To compare functional outcomes, specifically using the modified Rankin Scale (mRS).
- To assess the incidence of cardiocerebral vascular events and mortality in both treatment groups.
Main Methods:
- A comparative study involving 21 patients who underwent successful CAS and 41 patients receiving optimal medical therapy.
- Assessment of modified Rankin Scale (mRS) scores over a 2-year follow-up period.
- Comparison of combined cerebrovascular events and mortality rates between the CAS and medical therapy groups.
Main Results:
- Patients undergoing CAS demonstrated significantly lower mRS scores compared to the control group (P<0.05 or 0.01).
- The combined incidence of cerebrovascular events and mortality was lower in the CAS group (33.4% vs. 56.1%, P=0.045).
- Independent risk factors for major cerebrovascular events post-CAS included smoking, diabetes, and baseline NIH stroke scale scores.
Conclusions:
- Carotid artery stenting (CAS) offers superior functional outcomes compared to drug therapy for chronic internal carotid artery occlusion.
- CAS did not achieve a statistically significant reduction in cerebrovascular events or mortality rates.
- Larger, randomized clinical trials are essential to confirm the long-term benefits and safety of CAS in this patient population.
Aim:
Effects of carotid artery stenting (CAS) on patients with chronic internal carotid artery occlusion are unknown.
Methods:
This study included 21 patients who underwent successful CAS treatment and 41 patients who received optimal medical therapy. Modified Rankin Scale (mRS) and cardiocerebral vascular events were compared between CAS and medical therapy group.
Results:
The mRS in CAS group was lower than in control group during a 2-year follow up (P<0.05 or 0.01). The combined cerebrovascular events and mortality in study group was lower than in the control group (33.4% vs. 56.1%, P=0.045), but there was no statistically significant difference in the cerebrovascular event (28.6% vs. 46.3%, P=0.088) or mortality rate (4.8% vs. 9.8%, P=0.247) between the two groups. Cox regression analysis revealed that smoking (RR=3.189, 95% CI 1.020-9.968, P=0.046), diabetes (RR=2.717, 95% CI 1.113-6.631, P=0.028), and baseline National Institute of Health stroke scale (RR=2.984, 95% CI 1.049-8.485, P=0.040) were independent risk factors for major cerebrovascular events following CAS.
Conclusion:
CAS was superior to drug therapy in achieving better functional outcomes in patients with chronic internal carotid artery occlusion. However, CAS was not associated with a statistically significant reduction in cerebrovascular events or mortality. Larger and randomized clinical trials are required to ascertain the long-term benefits of CAS in patients with chronic internal carotid artery occlusion.
