The role of carotid artery stenting for recent cerebral ischemia.
Patients with cerebral ischemia as a result of acute cervical internal carotid artery occlusion are generally considered to have a poor prognosis. Despite maximal medical treatment, a better treatment for patients with acute ischemic stroke who present with serious neurologic symptoms on admission or continue to deteriorate neurologically due to a total occlusion, a dissection or a high-grade stenosis of the internal carotid artery is required. An effective intervention to improve their neurologic symptoms and clinical outcome has not yet been established and represents a challenging and complex problem. Treatment of acute symptomatic occlusion of the cervical internal carotid artery includes intravenous administration of thrombolytic agent, carotid endarterectomy and an interventional approach (intra-arterial administration of thrombolytic agent, transluminal angioplasty with or without stenting). The endovascular interventional approach is becoming a part of the stroke therapy armamentarium for intracranial occlusion. It may also now be considered in select patients with acute internal carotid artery occlusion. Stenting and angioplasty for acute internal carotid artery occlusion appears to be feasible, safe and may be associated with early neurological improvement. The encouraging preliminary results await confirmation from prospective, randomized studies.
Department Vascular Surgery, A.Z. Sint-Blasius, Dendermonde, Belgium. erwin.vinck@fmrp.be
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Bosiers
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Callaert
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Deloose
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Verbist
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Keirse
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Peeters
D000208:Acute Disease; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016894:Endarterectomy, Carotid; D006801:Humans; D020127:Recovery of Function; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome