Early carotid artery stenting for symptomatic carotid artery stenosis.
BACKGROUND
The aim of present study was to assess safety and efficacy of early carotid artery stent (CAS) in patients with symptomatic carotid artery stenosis compared with delayed CAS.


METHODS
This retrospective study was approved by the institutional review board, and the requirement to obtain written informed consent was waived. Outcomes of 206 patients with symptomatic carotid stenosis who were treated by CAS were analyzed. According to CAS timing from last symptom, patients were divided into early (within 2 weeks, 74 [35.0 %]) and delayed (after 2 weeks, 112 [64.1 %]) group by CAS timing from the last symptom. Procedural complication and early (≤30 days of CAS) event (ipsilateral stroke or any death) for safety, and late (31 days to 1 year of CAS) event for efficacy of CAS preventing further stroke were evaluated. The two groups were compared using Cox proportional hazard analysis.


RESULTS
No difference was found in procedural complication between the groups (early 2 [2.7 %] vs. delayed group 7 [5.3 %], hazard ratio [HR] 0.61, 95 % confidence interval [CI] 0.123-2.979, p = 0.537). In the early group, however, early event developed more frequently than in the late group (9 [12.2 %] vs. 1 [0.8 %], HR 16.05, 95 % CI 1.991-129.438, p = 0.009). The late event rate showed no difference between the two groups (4 [5.4 %] vs. 4 [3.0 %], HR 2.09, 95 % CI 0.484-8.989, p = 0.324).


CONCLUSIONS
Early CAS is not safe during periprocedural period, compared with late CAS. In CAS for symptomatic carotid stenosis, delayed CAS should be considered.
Department of Neurosurgery, Neurovascular Center of New Korea Hospital, Gimpo, Gyeonggi Province, South Korea.
Kyung Sun
KS
Song
Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, 300 Gumi-dong, Bungdang-gu, Seongnam, Gyeonggi, 463-707, South Korea. meurokwonoki@gmail.com.
O-Ki
OK
Kwon
Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, 300 Gumi-dong, Bungdang-gu, Seongnam, Gyeonggi, 463-707, South Korea.
Gyojun
G
Hwang
Department of Neurology, Seoul National University College of Medicine, Bundang Hospital, Seongnam, South Korea.
Hee-Joon
HJ
Bae
Department of Neurology, Seoul National University College of Medicine, Bundang Hospital, Seongnam, South Korea.
Moon-Ku
MK
Han
Department of Neurology, Seoul National University College of Medicine, Bundang Hospital, Seongnam, South Korea.
Beom Joon
BJ
Kim
Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, 300 Gumi-dong, Bungdang-gu, Seongnam, Gyeonggi, 463-707, South Korea.
Jae Seung
JS
Bang
Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, 300 Gumi-dong, Bungdang-gu, Seongnam, Gyeonggi, 463-707, South Korea.
Chang Wan
CW
Oh
D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology*; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods
Carotid artery stenosis; Complications; Delayed carotid stenting; Early carotid artery stenting