Early carotid artery stenting and angioplasty in patients with acute ischemic stroke.
OBJECTIVE
To determine the safety of early percutaneous endovascular carotid angioplasty and stenting (CAS) after an ischemic stroke.


METHODS
The neurointerventional database was reviewed for patients who underwent CAS after an acute ischemic stroke in two university hospitals. Clinical and radiological data were reviewed. Outcomes were worsening stroke, new stroke, or stroke-related death up to 30 days after the procedure. Procedure-related complications were also documented.


RESULTS
A total of 38 patients with 39 procedures were identified. The mean age was 67 +/- 15 years; 31 of 38 patients were Caucasian and 24 were female. Hypertension was found in 21 patients, peripheral vascular disease in 12, diabetes in 13, and coronary artery disease in 18. The median initial National Institutes of Health Stroke Scale score was 8. The carotid artery showed severe to high-grade stenosis in 28 patients, dissection was present in 6, and the rest had an acute occlusion treated with thrombolysis followed by CAS. The mean time from stroke onset to CAS was 55 +/- 34 hours. The mean degree of stenosis at baseline was 86 +/- 11%. In 37 procedures, complete recanalization was achieved, defined as less than 10% residual narrowing; in 2 procedures, the residual stenosis was mild (10-20%). Neurological deterioration occurred after three procedures (7.7%), with minor nondisabling stroke in two and death from intracranial hemorrhage in one.


CONCLUSIONS
If deemed necessary and in certain circumstances, early CAS seems to be safe after acute ischemic stroke if infarction volume is small and neurological deficit is mild.
Zaidat
Osama O
OO
Division of Interventional Neuroradiology, Duke University Health System, Durham, North Carolina 27710, USA.
Alexander
Michael J
MJ
Suarez
Jose I
JI
Tarr
Robert W
RW
Selman
Warren R
WR
Enterline
David S
DS
Smith
Tony P
TP
D000368:Aged; D017130:Angioplasty / Q000379:methods*; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D011859:Radiography; D015607:Stents