title: Early versus late carotid artery stenting for symptomatic carotid stenosis.
abstract: BACKGROUND
  Early carotid revascularization (≤ 14 days) is recommended for symptomatic carotid stenosis. Carotid artery stenting (CAS) has become an alternative to carotid endarterectomy (CEA); however, safety data on early CAS is controversial. The study aims to compare early versus late CAS, when CAS is performed as a first intention revascularization strategy.
  
  
  METHODS
  A retrospective analysis of all symptomatic patients admitted to our stroke unit who underwent CAS was conducted. Patients were divided between two groups: patients who had undergone CAS within 14 days after symptoms and those who had undergone CAS later. Primary endpoints were ipsilateral ischemic stroke or ipsilateral parenchymal hemorrhage (iPH) at 30 days. The secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) at the 30-day and at the 12-month follow-up.
  
  
  RESULTS
  One hundred twenty-seven consecutive patients were evaluated. Primary endpoints obtained in the early and late CAS groups were, respectively, ipsilateral stroke (2.0% vs. 2.6%, P = 1.00) and iPH (2.0% vs. 0.0%, P = 0.40). The rates of MACCE between the early and the late CAS groups were, respectively, (7.8% vs. 2.6%, P = 0.21) at the 30-day follow-up, and (12.2% vs. 10.5%, P = 0.77) at the 12-month follow-up.
  
  
  CONCLUSIONS
  In this study, CAS seems to be safe when used as first intention revascularization treatment within 2 weeks of symptoms, if infarcted area is less than one third of the middle cerebral artery territory. Our results need to be confirmed by larger studies.
authors.affiliation: Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Luis Henrique
authors.initials: LH
authors.lastname: de Castro-Afonso
authors.affiliation: Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Guilherme S
authors.initials: GS
authors.lastname: Nakiri
authors.affiliation: Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Monsignore
authors.affiliation: Division of Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Antônio C
authors.initials: AC
authors.lastname: dos Santos
authors.affiliation: Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: João Pereira
authors.initials: JP
authors.lastname: Leite
authors.affiliation: Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Soraia R C
authors.initials: SR
authors.lastname: Fábio
authors.affiliation: Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Pedro Telles
authors.initials: PT
authors.lastname: Cougo-Pinto
authors.affiliation: Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Millene Rodrigues
authors.initials: MR
authors.lastname: Camilo
authors.affiliation: Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Octávio M
authors.initials: OM
authors.lastname: Pontes-Neto
authors.affiliation: Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil. Electronic address: dgabud@fmrp.usp.br.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Abud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D002545:Brain Ischemia / Q000209:etiology / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: Carotid artery angioplasty stenting; Symptomatic carotid artery stenosis; Urgent carotid stenting