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Safety of Early Carotid Artery Stenting for Symptomatic Stenosis in Daily Practice.
- Source :
-
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2018 Dec; Vol. 56 (6), pp. 776-782. Date of Electronic Publication: 2018 Aug 31. - Publication Year :
- 2018
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Abstract
- Objective/background: In 2006, the American Heart Association recommended that for preference carotid endarterectomy (CEA) or, alternatively, carotid angioplasty and stenting (CAS) for symptomatic carotid artery stenosis should ideally occur within 14 days of an ischaemic event. The aim was to determine the safety of CAS according to those recommendations in daily practice.<br />Methods: A retrospective analysis was performed of all consecutive patients (2000-16), with ipsilateral carotid symptoms who underwent CAS for extracranial carotid stenosis ≥70%, who were previously included in a prospective database. Thirty day morbidity was assessed (any stroke without transient ischaemic attack [TIA]/amaurosis fugax), along with mortality of the procedure in the early (≤14 days after stroke onset) and delayed phases (15-180 days after stroke onset). Patients who received CAS and/or mechanical thrombectomy for acute ischaemic stroke treatment were not included.<br />Results: In total, 1227 patients with symptomatic carotid stenosis who underwent CAS were identified. Early and delayed CAS was performed in 291 and 936 patients, respectively. Morbidity (any stroke) and mortality was 2.2% (n = 27) in the whole cohort (n = 8 [2.7%] in early vs. n = 19 [2%] in delayed CAS; p = .47). There were no differences in morbidity between early and delayed CAS regarding TIA (n = 15 vs. 36 [5.2% vs. 3.9%]; p = .33), minor stroke (n = 4 vs. 5 [1.4% vs. 0.5%]; p = .14), or major stroke (n = 2 vs. 6 [0.7% vs. 0.6%]; p = .59). Two patients (0.7%) died after early CAS and eight (0.9%) after delayed CAS (p = .56).<br />Conclusion: CAS may be safely performed in the early phase after an ischaemic stroke with low clinical complication rates. Further studies are needed to validate CAS safety conducted even earlier in the acute phase of ischaemic stroke.<br /> (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Aged
Carotid Artery, External diagnostic imaging
Carotid Artery, External surgery
Female
Humans
Male
Middle Aged
Outcome Assessment, Health Care
Retrospective Studies
Risk Adjustment methods
Risk Factors
Spain epidemiology
Stents
Survival Analysis
Angioplasty adverse effects
Angioplasty instrumentation
Angioplasty methods
Angioplasty statistics & numerical data
Brain Ischemia diagnosis
Brain Ischemia epidemiology
Brain Ischemia etiology
Carotid Stenosis complications
Carotid Stenosis diagnosis
Carotid Stenosis epidemiology
Carotid Stenosis surgery
Endarterectomy, Carotid adverse effects
Endarterectomy, Carotid methods
Endarterectomy, Carotid statistics & numerical data
Stroke diagnosis
Stroke epidemiology
Stroke etiology
Time-to-Treatment
Subjects
Details
- Language :
- English
- ISSN :
- 1532-2165
- Volume :
- 56
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 30177414
- Full Text :
- https://doi.org/10.1016/j.ejvs.2018.07.026