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Early carotid artery stenting for symptomatic carotid artery stenosis

Acta Neurochirurgica volume 157, pages 1873–1878 (2015)Cite this article

Abstract

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.

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Fig. 1

References

  1. (1998) Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 351:1379–1387

  2. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sackett DL, Thorpe KE, Meldrum HE, Spence JD (1998) Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American symptomatic carotid endarterectomy trial collaborators. N Engl J Med 339:1415–1425

    CAS  Article  PubMed  Google Scholar 

  3. Bartoli MA, Squarcioni C, Nicoli F, Magnan PE, Malikov S, Berger L, Lerussi GB, Branchereau A (2009) Early carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke. Eur J Vasc Endovasc Surg 37:512–518

    CAS  Article  PubMed  Google Scholar 

  4. Blaisdell WF, Clauss RH, Galbraith JG, Imparato AM, Wylie EJ (1969) Joint study of extracranial arterial occlusion. IV. A review of surgical considerations. JAMA 209:1889–1895

    CAS  Article  PubMed  Google Scholar 

  5. Blaser T, Hofmann K, Buerger T, Effenberger O, Wallesch CW, Goertler M (2002) Risk of stroke, transient ischemic attack, and vessel occlusion before endarterectomy in patients with symptomatic severe carotid stenosis. Stroke 33:1057–1062

    Article  PubMed  Google Scholar 

  6. Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  7. Bruetman ME, Fields WS, Crawford ES, Debakey ME (1963) Cerebral hemorrhage in carotid artery surgery. Arch Neurol 9:458–467

    CAS  Article  PubMed  Google Scholar 

  8. Caplan LR, Skillman J, Ojemann R, Fields WS (1978) Intracerebral hemorrhage following carotid endarterectomy: a hypertensive complication? Stroke 9:457–460

    CAS  Article  PubMed  Google Scholar 

  9. Dosick SM, Whalen RC, Gale SS, Brown OW (1985) Carotid endarterectomy in the stroke patient: computerized axial tomography to determine timing. J Vasc Surg 2:214–219

    CAS  Article  PubMed  Google Scholar 

  10. Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, de Borst GJ, Lo TH, Gaines P, Dorman PJ, Macdonald S, Lyrer PA, Hendriks JM, McCollum C, Nederkoorn PJ, Brown MM (2010) Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (international carotid stenting study): an interim analysis of a randomised controlled trial. Lancet 375:985–997

    Article  PubMed  Google Scholar 

  11. Fisher M, Paganini-Hill A, Martin A, Cosgrove M, Toole JF, Barnett HJ, Norris J (2005) Carotid plaque pathology: thrombosis, ulceration, and stroke pathogenesis. Stroke 36:253–257

    Article  PubMed  Google Scholar 

  12. Gasecki AP, Ferguson GG, Eliasziw M, Clagett GP, Fox AJ, Hachinski V, Barnett HJ (1994) Early endarterectomy for severe carotid artery stenosis after a nondisabling stroke: results from the North American symptomatic carotid endarterectomy trial. J Vasc Surg 20:288–295

    CAS  Article  PubMed  Google Scholar 

  13. Gladstone DJ, Oh J, Fang J, Lindsay P, Tu JV, Silver FL, Kapral MK (2009) Urgency of carotid endarterectomy for secondary stroke prevention: results from the registry of the Canadian Stroke Network. Stroke 40:2776–2782

    Article  PubMed  Google Scholar 

  14. Golledge J, Cuming R, Beattie DK, Davies AH, Greenhalgh RM (1996) Influence of patient-related variables on the outcome of carotid endarterectomy. J Vasc Surg 24:120–126

    CAS  Article  PubMed  Google Scholar 

  15. Gonzalez A, Lopez-Rueda A, Gutierrez I, Moniche F, Cayuela A, Bustamante A, Mayol A, Gonzalez-Marcos JR, Gil-Peralta A (2012) Carotid plaque characterization by virtual histology intravascular ultrasound related to the timing of carotid intervention. J Endovasc Ther 19:764–773

    Article  PubMed  Google Scholar 

  16. Gorlitzer M, Froeschl A, Puschnig D, Locker E, Skyllouriotis P, Meinhart J, Kaucky M, Grabenwoeger M (2009) Is the urgent carotid endarterectomy in patients with acute neurological symptoms a safe procedure? Interact Cardiovasc Thorac Surg 8:534–537

    Article  PubMed  Google Scholar 

  17. Groschel K, Knauth M, Ernemann U, Pilgram SM, Schnaudigel S, Kastrup A (2008) Early treatment after a symptomatic event is not associated with an increased risk of stroke in patients undergoing carotid stenting. Eur J Neurol 15:2–5

    CAS  Article  PubMed  Google Scholar 

  18. Harrison GS, Mayberg MR (2000) Prospective randomized studies for carotid endarterectomy. Neurosurg Clin N Am 11:221–234

    CAS  PubMed  Google Scholar 

  19. Imai K, Mori T, Izumoto H, Watanabe M, Majima K (2005) Emergency carotid artery stent placement in patients with acute ischemic stroke. AJNR Am J Neuroradiol 26:1249–1258

    PubMed  Google Scholar 

  20. Jin SC, Kwon OK, Oh CW, Jung C, Han MG, Bae HJ, Lee SH, Jung YS, Han MH, Kang HS (2010) A technical strategy for carotid artery stenting: suboptimal prestent balloon angioplasty without poststenting balloon dilatation. Neurosurgery 67:1438–1442, discussion 1442–1433

    Article  PubMed  Google Scholar 

  21. Lal BK, Hobson RW 2nd, Pappas PJ, Kubicka R, Hameed M, Chakhtoura EY, Jamil Z, Padberg FT Jr, Haser PB, Duran WN (2002) Pixel distribution analysis of B-mode ultrasound scan images predicts histologic features of atherosclerotic carotid plaques. J Vasc Surg 35:1210–1217

    Article  PubMed  Google Scholar 

  22. Lee HO, Koh EJ, Choi HY (2010) Emergency carotid artery stent insertion for acute ICA occlusion. J Korean Neurosurg Soc 47:428–432

    PubMed Central  Article  PubMed  Google Scholar 

  23. Lovett JK, Coull AJ, Rothwell PM (2004) Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies. Neurology 62:569–573

    CAS  Article  PubMed  Google Scholar 

  24. Mantese VA, Timaran CH, Chiu D, Begg RJ, Brott TG (2010) The carotid revascularization endarterectomy versus stenting trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke 41:S31–34

    PubMed Central  Article  PubMed  Google Scholar 

  25. Moneta GL, Masser PA (1994) Randomized, multicenter trials of carotid endarterectomy. Ann Vasc Surg 8:403–408

    CAS  Article  PubMed  Google Scholar 

  26. Moore WS (1991) Efficacy of carotid endarterectomy in randomized trials. West J Med 155:407

    PubMed Central  CAS  PubMed  Google Scholar 

  27. Papanagiotou P, Roth C, Grunwald IQ, Ahlhelm F, Ernst N, Haass A, Reith W (2009) Carotid artery stenting for acute stroke. Radiologe 49:335–339

    CAS  Article  PubMed  Google Scholar 

  28. Pritz MB (1997) Timing of carotid endarterectomy after stroke. Stroke 28:2563–2567

    CAS  Article  PubMed  Google Scholar 

  29. Redgrave JN, Coutts SB, Schulz UG, Briley D, Rothwell PM (2007) Systematic review of associations between the presence of acute ischemic lesions on diffusion-weighted imaging and clinical predictors of early stroke risk after transient ischemic attack. Stroke 38:1482–1488

    Article  PubMed  Google Scholar 

  30. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ (2004) Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 363:915–924

    CAS  Article  PubMed  Google Scholar 

  31. Sundt TM Jr, Whisnant JP, Houser OW, Fode NC (1990) Prospective study of the effectiveness and durability of carotid endarterectomy. Mayo Clin Proc 65:625–635

    Article  PubMed  Google Scholar 

  32. Topakian R, Strasak AM, Sonnberger M, Haring HP, Nussbaumer K, Trenkler J, Aichner FT (2007) Timing of stenting of symptomatic carotid stenosis is predictive of 30 days outcome. Eur J Neurol 14:672–678

    CAS  Article  PubMed  Google Scholar 

  33. Welsh S, Mead G, Chant H, Picton A, O’Neill PA, McCollum CN (2004) Early carotid surgery in acute stroke: a multicentre randomised pilot study. Cerebrovasc Dis 18:200–205

    CAS  Article  PubMed  Google Scholar 

  34. Wiesmann M, Schopf V, Jansen O, Bruckmann H (2008) Stent-protected angioplasty versus carotid endarterectomy in patients with carotid artery stenosis: meta-analysis of randomized trial data. Eur Radiol 18:2956–2966

    Article  PubMed  Google Scholar 

  35. Wylie EJ, Hein MF, Adams JE (1964) Intracranial hemorrhage following surgical revascularization for treatment of acute strokes. J Neurosurg 21:212–215

    CAS  Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by grant no 02-2013-007 from the SNUBH Research Fund.

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speaker’s bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Affiliations

  1. Department of Neurosurgery, Neurovascular Center of New Korea Hospital, Gimpo, Gyeonggi Province, South Korea

    Kyung Sun Song

  2. Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, 300 Gumi-dong, Bungdang-gu, Seongnam, Gyeonggi, 463-707, South Korea

    O-Ki Kwon, Gyojun Hwang, Jae Seung Bang & Chang Wan Oh

  3. Department of Neurology, Seoul National University College of Medicine, Bundang Hospital, Seongnam, South Korea

    Hee-Joon Bae, Moon-Ku Han & Beom Joon Kim

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  1. Kyung Sun Song
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  2. O-Ki Kwon
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  3. Gyojun Hwang
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  5. Moon-Ku Han
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  8. Chang Wan Oh
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Correspondence to O-Ki Kwon.

Additional information

This study was not presented and has not been accepted for presentation at any meeting

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Song, K.S., Kwon, OK., Hwang, G. et al. Early carotid artery stenting for symptomatic carotid artery stenosis. Acta Neurochir 157, 1873–1878 (2015). https://doi.org/10.1007/s00701-015-2548-8

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  • DOI: https://doi.org/10.1007/s00701-015-2548-8

Keywords

  • Carotid artery stenosis
  • Early carotid artery stenting
  • Delayed carotid stenting
  • Complications