Acute carotid artery stenting in symptomatic high-grade cervical carotid artery stenosis.
The safety and efficacy of emergency carotid artery stenting (CAS) for patients with acute ischemic stroke resulting from internal carotid artery stenosis are not established. In this retrospective study, we evaluated outcomes for CAS performed within 2 weeks of acute ischemic stroke for 16 patients treated between December 2009 and February 2014. Cases of internal carotid artery occlusion, internal carotid dissection, or intracranial major arterial trunk occlusion were excluded. Five patients were treated with CAS during the hyperacute phase (within 24 h of stroke onset), three in the advanced phase (within 24 h of stroke-in-evolution after admission), and eight in the acute phase (24 h to 2 weeks after onset). We evaluated modified Rankin scale (mRS) scores 90 days after CAS. For patients treated during the hyperacute phase without intravenous tissue-type plasminogen activator (IV-tPA), two had mRS scores of 2 and one had a score of 3. Two patients treated in the hyperacute phase with IV-tPA had scores of 5: one with symptomatic intracerebral hemorrhage and the other with acute brain swelling. For patients treated in the advanced phase, mRS scores were 1, 3, and 5; the patient with 5 had contralateral cerebral infarction. All patients treated in the acute phase had scores of 2 or lower. Patients treated with IV-tPA in advanced or acute phases had no severe post-CAS complications. CAS was effective and safe for treating ischemic stroke within 2 weeks of onset. However, IV-tPA treatment may be a risk factor for CAS treatment during the hyperacute phase.
Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi, 470-1192, Japan. kazu-adachi@rio.odn.ne.jp.
Kazuhide
K
Adachi
Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi, 470-1192, Japan.
Akiyo
A
Sadato
Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi, 470-1192, Japan.
Motoharu
M
Hayakawa
Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi, 470-1192, Japan.
Shingo
S
Maeda
Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi, 470-1192, Japan.
Yuichi
Y
Hirose
D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000628:therapy; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D010959:Tissue Plasminogen Activator
Carotid artery stenting; Internal carotid artery stenosis; Intravenous tissue-type plasminogen activator; Stroke