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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Urgent Carotid Artery Stenting for Carotid-Related Stroke-in-Evolution
Nobuhiro Nakagawa1, Norihito Fukawa1, Kiyoshi Tsuji1
1Department of Neurosurgery, Kindai University Hospital, Osaka, Japan.
Insights
Urgent carotid artery stenting (CAS) effectively treats stroke-in-evolution (SIE) caused by carotid artery issues. This procedure improved patient outcomes and reduced stroke severity scores in a recent study.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Stroke-in-evolution (SIE) significantly impacts patient outcomes after acute ischemic stroke.
- The efficacy of surgical interventions for carotid artery-related SIE is debated.
Purpose of the Study:
- To assess carotid artery stenting (CAS) as a treatment option for carotid artery-related SIE.
- To evaluate the clinical outcomes of patients undergoing CAS for SIE.
Main Methods:
- Retrospective analysis of 10 patients with carotid-related SIE treated with CAS between May 2005 and December 2014.
- Patients presented with severe stenosis or occlusion, significant neurological deterioration (mean NIHSS 14.3), and impaired cerebral hemodynamics.
- CAS was performed urgently in the acute phase of SIE, with most cases utilizing flow reversal techniques.
Main Results:
- No procedure-related complications were observed, though one patient developed aspiration pneumonia.
- Mean NIHSS score decreased from 14.3 to 4.8 within 7 days post-CAS.
- 60% of patients achieved a modified Rankin Scale score of 0-2 at discharge, indicating good functional recovery.
Conclusions:
- Urgent CAS is a viable and effective treatment for carotid artery-related SIE with hemodynamic compromise.
- The procedure demonstrates potential for favorable clinical outcomes and functional recovery in selected patients.
Background:
Stroke-in-evolution (SIE) is a major outcome determinant in patients with acute ischemic stroke. The benefit of surgery for treatment of carotid artery-related SIE remains controversial.
Objective:
To retrospectively evaluate the use of carotid artery stenting (CAS) as a possible alternative treatment in patients with carotid-related SIE.
Methods:
Ten patients with carotid-related SIE were treated with CAS from May 2005 to December 2014. The mean initial National Institutes of Health Stroke Scale (NIHSS) score was 5.4 ± 4.4. Two patients had total occlusion of the internal carotid artery, and 8 had severe stenosis. The mean interval from symptom onset to clinical deterioration was 2.9 ± 2.9 d. The mean NIHSS score after deterioration was 14.3 ± 4.5. In the hemodynamic assessment using perfusion imaging, the ipsilateral cerebral hemodynamics was impaired in 7 of 8 patients.
Results:
All patients underwent urgent CAS in the acute phase of SIE. Seven patients underwent CAS using flow reversal with or without distal protection. No procedure-related complications occurred in any patients, although 1 patient developed aspiration pneumonia. The mean NIHSS score 7 d after CAS was 4.8 ± 2.3. Six patients (60%) had a modified Rankin scale score of 0 to 2 at discharge.
Conclusion:
Urgent CAS for carotid-related SIE with hemodynamic impairment appears to be an effective method for achieving good clinical outcomes.
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