title: Treatment Outcome of Carotid Artery Stenting Underwent within 14 Days of Stroke Onset - Consideration of Safety and Efficacy of Urgent Carotid Artery Stenting for Neurologically Progressing Patients.
abstract: As the safety and effectiveness of urgent carotid artery stenting (CAS) for neurologically progressing patients remain controversial, we retrospectively analyzed the outcome of urgent CAS based on the patients' pathophysiological condition and neuroimaging findings. We divided 71 patients who underwent CAS within 14 days of stroke onset into two groups. Group 1 (n = 35) was comprised of patients with progressing neurologic signs and a reversible ischemic penumbra on magnetic resonance images (MRI). They were treated by urgent CAS. Group 2 (n = 36) was neurologically stable and underwent prophylactic CAS. In all patients we recorded the National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin scale (mRS). Urgent CAS resulted in significant improvement in the NIHSS score, when compared before and after CAS in group 1 (5.3 ± 4.3, P < 0.01). The rate of good outcomes (mRS 0-2 at 3 months post-CAS) was 48.6% in group 1, and 75% in group 2. The cumulative incidence of ipsilateral stroke between 31 days and 1 year was 5.9% in group 1, and 0% in group 2. The procedural complication rate was similar in both groups (group 1: 5.7%, n = 2; group 2: 5.6%, n = 2). No patient suffered a symptomatic intracerebral hemorrhage. When the pathophysiological status and neuroimaging findings are used to determine patient eligibility for urgent CAS, this treatment improve neurologic outcome and can be performed as safely as prophylactic CAS in our cohort of patients with acute ischemic stroke.
authors.affiliation: Department of Neurosurgery, Tokushima University.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Kanematsu
authors.affiliation: Department of Neurosurgery, Tokushima University.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Satomi
authors.affiliation: Department of Neurosurgery, Tokushima University.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kuwayama
authors.affiliation: Department of Neurosurgery, Tokushima University.
authors.forename: Izumi
authors.initials: I
authors.lastname: Yamaguchi
authors.affiliation: Department of Neurosurgery, Tokushima University.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Yoshioka
authors.affiliation: Department of Neurosurgery, Tokushima University.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kinouchi
authors.affiliation: Department of Neurosurgery, Tokushima University.
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Tada
authors.affiliation: Department of Clinical Neuroscience, Tokushima University.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Kawasaki Medical School.
authors.forename: Shunji
authors.initials: S
authors.lastname: Matsubara
authors.affiliation: Department of Neurosurgery, Tokushima Red Cross Hospital.
authors.forename: Koichi
authors.initials: K
authors.lastname: Satoh
authors.affiliation: Department of Neurosurgery, Tokushima University.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy*; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: acute ischemic stroke; urgent carotid artery stenting