Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Clinical Analysis of Carotid Artery Stenting in Symptomatic High-Risk Patients : A Single Stroke Center Study

  • Ahn, Sang-Soak (Department of Radiology, College of Medicine, Dong-A University) ;
  • Kang, Myung-Jin (Department of Neurosurgery, College of Medicine, Dong-A University) ;
  • Choi, Jae-Hyung (Department of Radiology, College of Medicine, Dong-A University)
  • Published : 2010.06.30
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Abstract

Objective : The early management of patients with acute symptoms due to carotid stenosis remains a subject of debate. Carotid endarterectomy (CEA) has been shown to reduce the risk of stroke in patients with symptomatic extracranial carotid artery stenosis. Carotid artery stenting (CAS) has recently emerged as an alternative to CEA for the primary and secondary prevention of stroke in patients who are at a high risk for complications from surgery. The aim of this study is to evaluate and analyze the clinical outcome of symptomatic high-risk patients with carotid stenosis that was treated with early CAS in a single stroke center. Methods : From January 2008 to October 2009, we retrospectively analyzed 75 symptomatic high-risk carotid stenosis patients who had been admitted to the stroke center of our neurosurgical department and who were treated with early CAS. Twenty-five patients had transient ischemic attack (TIA) and 50 patients had minor or major stroke and all of them were at a high medical and surgical risk for carotid endarterectomy. They were treated with early CAS as soon as possible (treatment was done within 2 weeks from the onset of symptoms). Results : At three months, 15 patients (20%) in the TIA and stroke group experienced an improvement in their initial neurologic deficit (a decreased modified Rankin scale greater than 2), while in 59 patients (78.4%) the deficit remained stable, and only one patient had a neurological impairment. Conclusion : Our data indicates that urgent assessment and early initiation of a combination of existing preventive treatments can reduce the risk of early recurrent stroke after TIA and minor or major stroke in the symptomatic high-risk patients with carotid stenosis.

Keywords

References

  1. Berg-Drammer E, Henkes H, Weber W, Berlit P, Kuhne D. Percutaneous transluminal angioplasty of intracranial artery stenosis : clinical results in 24 patients. Neurosurg Focus 5:1-14, 1998
  2. Bonita R, Beaglehole R : Modification of Rankin scale. recovery of motor function after stroke. Stroke 19:1497-1500, 1988
  3. Bussiers M, Pelz DM, Kalapos P, Lee D, Gulka I, Leung A, et al. Results using a self-expanding stent alone in the treatment of severe symptomatic carotid bifurcation stenosis. J Neurosurg 109:454-460, 2008 https://doi.org/10.3171/JNS/2008/109/9/0454
  4. Das S, Bendok BR, Getch CC, Awad I, Batjer HH. Update on current registries and trials of carotid artery angioplasty and stent placement. Neurosurg Focus 18:1-6, 2005
  5. Fessler RD, Wakhloo AK, Lanzio G, Qureshi AI, Guterman LR, Hopkins LN, et al. Stent placement for vertebral artery occlusive disease : preliminary clinical experience. Neurosurg Focus 5:1-8, 1998
  6. Ghogawala Z, Westerveld M, Amin-Hanjani S. Cognitive outcomes after carotid revascularization : The role of cerebral emboli and hypoperfusion. Neurosurgery 62:385-395, 2008 https://doi.org/10.1227/01.neu.0000316005.88517.60
  7. Grant A, White C, Ansel G, Bacharach M, Mezger C, Velez C, et al. Safety and efficacy of carotid stenting in the very elderly. Catheter Cardiovasc Interv 10:1-5, 2010
  8. Iihara K, Murao K, Sakai N, Yamada N, Nagata I, Miyamoto S, et al. Outcome of carotid endarterectomy and stent insertion based on grading of carotid endarterectomy risk : a 7-year prospective study. J Neurosurg 105:546-554, 2006 https://doi.org/10.3171/jns.2006.105.4.546
  9. Komotar RJ, Mocco J, Wilson DA, Connolly ES, Lavine SD, Meyers PM, et al. Current endovascular treatment options for intracranial carotid artery atherosclerosis. Neurosurg Focus 18:1-4, 2005
  10. Komotar RJ, Mocco J, Wilson DA, Connolly ES, Lavine SD, Meyers PM, et al. The natural history of intracranial carotid artery atherosclerosis. Neurosurg Focus 18:1-3, 2005
  11. Kwon YK, Kim EM, Lee CY. Stent-assisted angioplasty for symptomatic radiation-induced carotid stenosis. J Korean Neurosurg Soc 41:327-329, 2007
  12. Lanzino G, Fessler RD, Mericle RA, Wakhloo AK, Guterman LR, Hopkins LN, et al. Angioplasty and stenting for carotid artery stenosis : indications, techniques, results, and complications. Neurosurg Focus 5:1-23, 1998
  13. Lanzino G, Mericle RA, Lopes DK, Wakhloo AK, Guterman LR, Hopkins LN, et al. Percutaneous transluminal angioplasty and stenting for recurrent carotid artery stenosis. Neurosurg Focus 5:1-9,1998
  14. Lee CY, Yim MB. Primary stent therapy for symptomatic intracranial atherosclerotic stenosis : 1-year follow-up angiographic and midterm clinical outcomes. J Neurosurg 105:235-241,2006 https://doi.org/10.3171/jns.2006.105.2.235
  15. Levy EL, Ecker RD, Thompson JJ, Rosella PA, Hanel RA, Guterman LR, et al. Toward clinical equipoise : the current case for carotid angioplasty and stent placement. Neurosurg Focus 18:1-8,2005
  16. Levy EL, Hanel RA, Bendok BR, Boulos AS, Hartney ML, Guterman LR, et al. Staged stent-assisted angioplasty for symptomatic intracranial vertebrobasilar artery stenosis. J Neurosurg 97:1294-1301, 2002 https://doi.org/10.3171/jns.2002.97.6.1294
  17. Levy EL, Hanel RA, Boulos AS, Bendok BR, Kim SH, Gibbons KJ, et al. Comparison of procedure complications resulting from direct stent placement compared with those due to conventional and staged stent placement in the basilar artery. J Neurosurg 99:653-660, 2003 https://doi.org/10.3171/jns.2003.99.4.0653
  18. Levy EL, Hanel RA, Lau T, Koebbe CJ, Levy N, Padalino DJ, et al. Frequency and management of recurrent stenosis after carotid artery stent implantation. J Neurosurg 102:29-37, 2005
  19. Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C. Endovascular reconstruction of intracranial arteries by stent placement and combined technique. J Neurosurg 97:1306- 1313,2002 https://doi.org/10.3171/jns.2002.97.6.1306
  20. Meyer FB. Overview : carotid endarterectomy compared with angioplasty. Neurosurg Focus 18:1-3, 2008
  21. Nederkoorn PJ, Brown MM. Optimal cut-off criteria for duplex ultrasound for the diagnosis of restenosis in stented carotid arteries : review and protocol for a diagnostic study. BMC Neurol 9:1-7, 2009 https://doi.org/10.1186/1471-2377-9-1
  22. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445-453, 1991 https://doi.org/10.1056/NEJM199108153250701
  23. Park ST, Kim JK, Yoon KH, Park SO, Park SW, Kim JS, et al. Atherosclerotic carotid stenoses of apical versus body lesions in high-risk carotid stenting patients. AJNR Am J Neuroradiol:1-7, 2010
  24. Rabih AC, Makaroun MS. Current indications for carotid angioplasty and stenting. Perspect Vasc Surg Endovasc Ther 20:239-245,2008 https://doi.org/10.1177/1531003508323731
  25. Setacci C, Donato G, Chisci E, Stacci F, Italy S. Carotid artery stenting in recently symptomatic patient : a single center experience. Ann Vasc Surg:1-5,2009
  26. Steinfort B, Ng PP, faulder K, Harrington T, Grinnel V, Sorby W, et al. Midterm outcomes of paclitaxel-eluting stents for the treatment of intracranial posterior circulation stenoses. J Neurosurg 106:222-225,2007 https://doi.org/10.3171/jns.2007.106.2.222
  27. Taha MM, Maeda M, Sakaida H, Kawaguchi K, Toma N, Yamamoto A, et al. Cerebral ischemic lesions detected with diffusion-weighted magnetic resonance imaging after carotid artery stenting : comparison of several anti-embolic protection devices. Neurol Med Chir (Tokyo) 49:386-393, 2009 https://doi.org/10.2176/nmc.49.386
  28. Terada T, Tsuura M, Matsumoto H, Masuo O, Tsumoto T, Yamaga H, et al. Endovascular therapy for stenosis of the petrous or cavernous portion of the internal carotid artery : percutaneous transluminal angioplasty compared with stent placement. J Neurosurg 98:491-497, 2003 https://doi.org/10.3171/jns.2003.98.3.0491
  29. Theron J, Guimaraens L, Coskun O, Sola T, Martin JB, Rufenacht DA, et al. Complications of carotid angioplasty and stenting. Neurosurg Focus 5:1-20, 1998
  30. Vajda Z, Miloslavski E, Guthe T, Schmid E, Schul C, Albes G, et al. Treatment of intracranial atherosclerotic arterial stenoses with a balloon-expandable cobalt chromium stent (coroflex blue) : procedural safety, efficacy, and midterm patency. Neuroradiology:1-7, 2009
  31. Yoon SM, Jo KW, Baik MW, Kim YW. Delayed carotid wallstent shortening resulting in restenosis following successful carotid artery angioplasty and stenting. J Korean Neurosurg Soc 46:495-497, 2009 https://doi.org/10.3340/jkns.2009.46.5.495