title: Urgent carotid artery stenting with technical modifications for patients with transient ischemic attacks and minor stroke.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of urgent carotid artery stenting (CAS) with technical modifications in patients with recent (<24 hours) initial or recurrent (≥2 episodes in 24 hours) transient ischemic attacks (TIA) or with minor stroke.
  
  
  METHODS
  A single-center, prospective, observational study was begun in March 2005 to assess an urgent CAS protocol for the treatment of selected high-risk patients with carotid artery disease who presented within 24 hours of an initial or recurrent TIA or minor stroke. Up to June 2011, 78 patients (59 men; mean age 76 years) with TIA (n=57) or minor stroke (n=21) underwent urgent CAS (within 48 hours) for severe internal carotid artery stenosis. Outcome measures were major adverse cardiac and cerebrovascular events (MACCE), modifications in the National Institutes of Health Stroke Scale (NIHSS) values for minor stroke patients, and postoperative stroke and death rates.
  
  
  RESULTS
  Technical and procedural success rates were 100% and 97.4%, respectively; 1 intraoperative minor stroke occurred due to stent thrombosis. At 30 days, 2 patients had recurrent minor stroke; one subsequently died after a hemorrhagic brain infarction. The MACCE rate was 3.8%. There were no cases of myocardial infarction or access-related complications. Of the 20 surviving minor stroke patients, 14 showed improvement in neurological deficit on the NIHSS scale at 30 days, while 5 remained stable and one was neurologically impaired.
  
  
  CONCLUSIONS
  Urgent CAS in selected patients with symptomatic carotid stenosis was satisfactory in preventing the recurrence of TIA and stroke in this study. Urgent CAS with careful patient selection, contemporary tools (medical and technical), and expert technique may represent a possible solution for some patients with recent or recurrent TIA or minor stroke.
authors.affiliation: Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino Estense, Modena, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Moratto
authors.forename: Jessica
authors.initials: J
authors.lastname: Veronesi
authors.forename: Roberto
authors.initials: R
authors.lastname: Silingardi
authors.forename: Njila Mistral Klend
authors.initials: NM
authors.lastname: Sacha
authors.forename: Giulia
authors.initials: G
authors.lastname: Trevisi Borsari
authors.forename: Giovanni
authors.initials: G
authors.lastname: Coppi
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Coppi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D009460:Neurologic Examination; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome