Carotid Artery Stent Placement and Carotid Endarterectomy: A Challenge for Urgent Treatment after Stroke-Early and 12-Month Outcomes in a Comprehensive Stroke Center
| Autor: | Arnaldo Ippoliti, Nicola Toschi, Jacopo M. Legramante, Alessandro Rocco, Marina Diomedi, Roberto Gandini, Enrico Pampana, Barbara Rizzato, Andrea Ascoli Marchetti, Fabrizio Sallustio |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Carotid endarterectomy 030204 cardiovascular system & hematology Settore MED/22 - Chirurgia Vascolare 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale Recurrence Risk Factors Internal medicine medicine.artery medicine Secondary Prevention Humans Radiology Nuclear Medicine and imaging Carotid Stenosis cardiovascular diseases Stroke Endarterectomy Aged Retrospective Studies Aged 80 and over Endarterectomy Carotid business.industry Endovascular Procedures Stent Settore MED/37 - Neuroradiologia Retrospective cohort study Middle Aged medicine.disease Stenosis Treatment Outcome Ischemic Attack Transient Cardiology Feasibility Studies Settore MED/26 - Neurologia Female Stents Internal carotid artery Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | Journal of vascular and interventional radiology : JVIR. 29(9) |
| ISSN: | 1535-7732 |
| Popis: | To compare feasibility, 12-month outcome, and periprocedural and postprocedural risks between carotid artery stent (CAS) placement and carotid endarterectomy (CEA) performed within 1 week after transient ischemic attack (TIA) or mild to severe stroke onset in a single comprehensive stroke center.Retrospective analysis of prospective data collected from 1,148 patients with ischemic stroke admitted to a single stroke unit between January 2013 and July 2015 was conducted. Among 130 consecutive patients with symptomatic carotid stenosis, 110 (10 with TIA, 100 with stroke) with a National Institutes of Health Stroke Scale (NIHSS) score20 and a prestroke modified Rankin Scale (mRS) score2 were eligible for CAS placement or CEA and treated according to the preference of the patient or a surrogate. Periprocedural (48 h) and postprocedural complications, functional outcome, stroke, and death rate up to 12 months were analyzed.Sixty-two patients were treated with CAS placement and 48 were treated with CEA. Several patients presented with moderate or major stroke (45.8% CEA, 64.5% CAS). NIHSS scores indicated slightly greater severity at onset in patients treated with a CAS vs CEA (6.6 ± 5.7 vs 4.2 ± 3.4; P = .08). Complication rates were similar between groups. mRS scores showed a significant improvement over time and a significant interaction with age in both groups. Similar incidences of death or stroke were shown on survival analysis. A subanalysis in patients with NIHSS scores ≥ 4 showed no differences in complication rate and outcome.CAS placement and CEA seem to offer early safe and feasible secondary stroke prevention treatments in experienced centers, even after major atherosclerotic stroke. |
| Databáze: | OpenAIRE |
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