title: Safety and effectiveness of emergency carotid artery stenting for a high-grade carotid stenosis with intraluminal thrombus under proximal flow control in hyperacute and acute stroke.
abstract: BACKGROUND
  A study was undertaken to investigate the feasibility, safety and effectiveness of emergency carotid artery stenting (eCAS) for a high-grade carotid stenosis with intraluminal thrombus (ILT) with or without proximal flow control (PFC).
  
  
  METHODS
  Patients with acute ischemic stroke included in the analysis were those who were admitted between 2001 and 2010 with serious neurological symptoms, without a large high-intensity area of diffusion-weighted images and who underwent eCAS for a high-grade carotid stenosis with ILT. Patients underwent eCAS without PFC until 2004 (group C) and under PFC after 2004 (group P). The National Institutes of Health Stroke Scale (NIHSS) score on admission, just before CAS and 7 days after CAS as well as the 3-month modified Rankin Scale were investigated.
  
  
  RESULTS
  Fifty-six patients underwent eCAS, eight of whom had a high-grade stenosis with ILT. Four of the eight patients were in group C and four were in group P. Probable distal embolism associated with eCAS occurred in two cases in group C and in none in group P. In groups C and P the median 7-day NIHSS scores were 15 and 5, respectively (p<0.05) and the median 3-month modified Rankin Scale scores were 4 and 2, respectively (p<0.05), but there were no significant differences between the two groups in the NIHSS scores on admission and just before CAS.
  
  
  CONCLUSIONS
  In stroke patients with a high-grade carotid stenosis with ILT, eCAS under PFC is safer and more effective in achieving a favorable clinical outcome than eCAS without PFC.
authors.affiliation: Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Kamakura City, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Iwata
authors.forename: Takahisa
authors.initials: T
authors.lastname: Mori
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tajiri
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Masahito
authors.initials: M
authors.lastname: Nakazaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome