Urgent Treatment for Symptomatic Carotid Stenosis: The Pittsburgh Revascularization and Treatment Emergently After Stroke (PIRATES) Protocol.

Autor:	Jankowitz BT; Cooper Neurological Institute, Camden, New Jersey., Tonetti DA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Kenmuir C; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Rao R; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Ares WJ; Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois., Zussman B; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Brown MW; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Stone JG; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Gardner PA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Friedlander RM; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Gross BA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Jadhav AP; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Jovin TG; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2020 Sep 15; Vol. 87 (4), pp. 811-815.
DOI:	10.1093/neuros/nyaa096
Abstrakt:	Background: Patients with symptomatic carotid stenosis remain at high risk of early recurrent stroke without revascularization. This risk must be balanced against a higher rate of periprocedural complications associated with early revascularization. Objective: To analyze prospectively recorded data from an institutional protocol that standardized the urgent (<48 h) treatment of patients presenting with symptomatic carotid stenosis and underwent either carotid stenting (CAS) or carotid endarterectomy (CEA). Methods: All patients presenting over 28 mo to a comprehensive stroke center with symptomatic carotid stenosis within 48 h of index event were screened for inclusion. All patients were given dual-antiplatelet therapy. If there was clinical equipoise between CEA and CAS, patients underwent angiography and subsequently revascularization if digital subtraction angiography demonstrated ≥50% stenosis. The primary outcome was a composite of stroke or death within 30 d. Results: This study included 178 patients with a diagnosis of recently symptomatic carotid stenosis; 120 patients (67%) met the criteria. A total of 59 patients underwent CEA and 61 patients underwent CAS. There were not significant differences in the primary outcome; 3 patients (5.1%) in the CEA arm and 3 patients (4.9%) in the CAS arm met the primary outcome. Conclusion: In this prospective analysis, urgent revascularization for symptomatic carotid stenosis can be done with equivalently low rates of stroke or death, regardless of revascularization strategy. (Copyright © 2020 by the Congress of Neurological Surgeons.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu