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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Outcomes after carotid revascularization for symptomatic carotid artery web: A multi-institutional cohort study
Michael T Bounajem1, Allison Liang1, Annie Trang2
1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
Insights
Carotid web treatment with stenting (CAS) or endarterectomy (CEA) is safe and effective for preventing recurrent strokes. Both procedures showed similar low complication and stroke recurrence rates in a study of symptomatic carotid web patients.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Carotid webs can cause clot formation and lead to thromboembolic stroke.
- Current antiplatelet therapy shows high recurrent stroke rates despite optimal medical management.
- Symptomatic carotid web necessitates evaluation for effective intervention.
Purpose of the Study:
- To evaluate the safety and efficacy of carotid artery stenting (CAS) and carotid endarterectomy (CEA) for symptomatic carotid web.
- To compare recurrent stroke rates and postoperative complications between CAS and CEA.
- To assess the long-term outcomes of interventions for carotid web-induced stroke or TIA.
Main Methods:
- A multi-institutional retrospective registry of adult patients with symptomatic carotid web was analyzed.
- Patients treated with either CAS or CEA for ipsilateral acute ischemic stroke or TIA were included.
- Demographics, comorbidities, clinical presentation, treatment details, and follow-up outcomes were collected and analyzed.
Main Results:
- 71 patients (32.4% CEA, 67.6% CAS) were included, with a mean age of 52.4 years.
- Perioperative stroke occurred in 1.41% of patients; no myocardial infarctions were reported.
- During a mean follow-up of 14.8 months, only one patient (1.41%) experienced asymptomatic recurrent stroke.
Conclusions:
- Both carotid artery stenting and endarterectomy are safe and effective treatments for carotid web.
- These interventions significantly reduce the risk of subsequent stroke in patients with symptomatic carotid web.
- Further research is needed to determine the optimal timing and procedural choice for carotid web treatment.
Abstract:
ObjectiveCarotid web can serve as a nidus for clot formation and subsequent thromboembolic stroke. Although treatment historically involved antiplatelet therapy, recent evidence demonstrates notably elevated recurrent stroke rates despite best medical therapy. We examined the safety and efficacy of carotid artery stenting (CAS), which involves placing a coil in the artery, and carotid endarterectomy (CEA), a surgery to remove the clot, for treatment of symptomatic carotid web.MethodsA multi-institutional retrospective registry including adult patients with carotid web with history of ipsilateral acute ischemic stroke or transient ischemic attack (TIA) treated with either carotid artery stenting or endarterectomy was reviewed. Patient demographics, comorbidities, clinical presentation, treatment methodology, and outcomes at follow up were collected.ResultsAmong the 71 included patients (mean age 52.4 years, 44 (62.4%) female), 23 (32.4%) underwent CEA, and 48 (67.6%) underwent CAS. The most common presenting symptoms were hemibody numbness/weakness, aphasia, and gaze deviation. On average, patients had experienced 1.12 ± 0.7 strokes or TIAs before intervention, with a mean delay of 115 ± 224 days between initial stroke/TIA and intervention. The median preintervention modified Rankin Scale (mRS) score was 2. Perioperatively, one patient (1.41%) experienced stroke and none experienced myocardial infarction. During mean 14.8 (±29.2)-month follow up, one patient experienced asymptomatic recurrent stroke (1.41%). Median mRS at follow up was 1, and carotid artery stenting and endarterectomy demonstrated similar rates of postoperative complication and recurrent stroke rates.ConclusionOur results suggest that endarterectomy and stenting are safe and efficacious for minimizing subsequent stroke risk in patients who have experienced stroke or TIA from carotid webbing, warranting further studies to determine the optimal timing and method of treatment.
