Clinical Comparison of Outcomes of Early versus Delayed Carotid Artery Stenting for Symptomatic Cerebral Watershed Infarction due to Stenosis of the Proximal Internal Carotid Artery

Liu, Huakun; Chu, Jianfeng; Zhang, Lei; Liu, Chaolai; Yan, Zhongrui; Zhou, Shiyue

doi:10.1155/2016/6241546

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…Current guidelines are to pursue early revascularization within 14 days of AIS [ 2 ]. Due to the increasing risk of recurrence within the first 2 weeks after the first ischemic event of a symptomatic carotid stenosis, Liu et al showed improved functional outcomes without increasing the rate of new AIS, myocardial infarction or death in the early CAS group (<1 week) compared to the delayed CAS at 1 month [ 28 ]. On the contrary, Song et al evaluated CAS for 206 patients with moderate-to-severe stenosis and found a significantly higher rate of ipsilateral stroke or death (at 30 days) of 12.8% in the early CAS group (within 14 days) compared to only 0.8% in the delayed CAS group (mean timing of CAS was 52.6 ± 36.94 days) [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

MRI Outcomes Achieved by Simple Flow Blockage Technique in Symptomatic Carotid Artery Stenosis Stenting

Hak

Arquizan

Mahmoudi

et al. 2022

JPM

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In this study, we aimed to determine the frequency and clinical impact of new ischemic lesions detected with diffusion-weighted-imaging-MRI (DWI-MRI) as well as the clinical outcomes after carotid artery stenting (CAS) using the simple flow blockage technique (SFB). This is a retrospective study with data extraction from a monocentric prospective clinical registry (from 2017 to 2019) of consecutive patients admitted for symptomatic cervical ICA stenosis or web. Herein, patients benefited from DWI-MRI before and within 48 h of CAS for symptomatic ICA stenosis or web. The primary endpoint was the frequency of new DWI-MRI ischemic lesions and the secondary (composite) endpoint was the rate of mortality, symptomatic stroke or acute coronary syndrome within 30 days of the procedure. All of the 82 CAS procedures were successfully performed. Among the 33 patients (40.2%) with new DWI-MRI ischemic lesions, 30 patients were asymptomatic (90.9%). Irregular carotid plaque surface with (n = 13, 44.8%) or without ulceration (n = 12, 60.0%) was associated with higher rates of new DWI-MRI lesions by comparison to patients with a regular plaque (n = 7, 25%) (p = 0.048) using the univariate analysis. Less than half of this CAS cohort using the SFB technique had new ischemic lesions detected with DWI-MRI. Among these patients, more than 90% were asymptomatic. Irregularity of the plaque seems to increase the risk of peri-procedural DWI-MRI lesions.

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Section: Discussionmentioning

confidence: 99%

MRI Outcomes Achieved by Simple Flow Blockage Technique in Symptomatic Carotid Artery Stenosis Stenting

Hak

Arquizan

Mahmoudi

et al. 2022

JPM

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“…In the past, it was believed that the risk of early recurrent TIA or stroke after the onset of neurological symptoms is not high, so CEA should be delayed for at least 6 weeks after an onset of neurological symptoms, and operating early on a recently symptomatic “unstable” carotid plaque was associated with an increased risk of perioperative stroke [ 2 ]. In recent years, early surgical intervention within 1-2 weeks of symptom onset has been advocated for patients with symptomatic carotid artery stenosis [ 3 ]. Therefore, the timing of CEA surgery has been gradually attracted the attention of all, and studies on it have also increased gradually in recent years.…”

Section: Introductionmentioning

confidence: 99%

[Retracted] Safety and Efficacy of Early Carotid Endarterectomy in Patients with Symptomatic Carotid Artery Stenosis: A Meta‐Analysis

Chen

Wang

et al. 2021

BioMed Research International

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Background and Purpose. This study is aimed at assessing the differences in postoperative stroke, myocardial infarction (MI), and mortality in patients with symptomatic carotid artery stenosis (sCAS) treated with early or late carotid endarterectomy (CEA) to determine and compare the safety of different operation timing. Design. A systematic document retrieval of studies published in the past 10 years reporting periprocedural stroke/mortality/MI after carotid endarterectomy (CEA) related to the time between CEA and qualifying neurological symptoms. The application database has “PubMed, EMbase and Cochrane databases.” RevMan5.3 software provided by the Cochrane collaboration was used for meta-analysis. Results. A systematic literature search was conducted in databases. A total of 10 articles were included in this study. They were divided into early CEA and delayed CEA with operation within 48 h, 1 w, or 2 w after onset of neurological symptoms. Incidence of the postoperative stroke in patients undergoing delayed CEA (≥48 h) was significantly higher than patients with delayed CEA (<48 h) ( OR = 2.14 , 95% CI: 1.43-3.21, P = 0.0002 ). The postoperative mortality of patients after delayed CEA (≥48 h) was significantly higher than patients after early CEA (<48 h) ( OR = 1.35 , 95% CI: 1.06-1.71, P = 0.02 ). The risk of postoperative mortality of patients treated with delayed CEA (≥7 d) was significantly higher than patients after the early CEA group (<7 d) ( OR = 1.69 , 95% CI: 1.21-2.32, P = 0.001 ). Conclusion. Early CEA is safe and effective for a part of patients with symptomatic carotid stenosis, but a comprehensive preoperative evaluation of patients with carotid stenosis must be performed.

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“…4,5 In contrast, other studies supported early CAS within their 7 or 15 days cut-off, showing no significant differences in stroke or deaths at 30 days. 6,7,17,18 A recent prospective study compared CAS to CEA when performed within the first 48 hours and found similar rates of stroke or any cause of death within 30 days (5.1% vs. 4.9%, respectively). 19 Those findings are comparable to the primary outcome rate in our emergency CAS group (5.7%).…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of symptomatic carotid artery stenting performed in an emergency setting

et al. 2020

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Introduction Carotid artery stenting (CAS) has increasingly emerged as an alternative strategy to carotid endarterectomy in the treatment of patients with symptomatic carotid stenosis. Optimal timing for CAS after symptoms onset remains unclear. We aimed to evaluate the safety and efficacy of CAS when performed in an emergency setting. Patients and methods We performed a retrospective analysis of CAS patients admitted to our CSC with symptomatic extracranial carotid occlusion or significant stenosis from January 2014-September 2019. Emergency CAS was defined as CAS performed during the same hospitalization from TIA/stroke onset, whereas elective CAS as CAS performed on a subsequent admission. The primary outcome was defined as the occurrence of any stroke, myocardial infarction, or death related to the procedure at 3 months of follow-up. Secondary outcomes included periprocedural complications and the rate of restenosis/occlusion at follow-up. Logistic regression and survival analyses were used to compare outcomes and restenosis at follow-up. Results We identified 75 emergency and 104 elective CAS patients. Emergency CAS patients had significantly higher rates of ipsilateral carotid occlusion (17% vs. 2%, p < 0.001) and use of general anesthesia (19% vs. 4%, p = 0.001) than elective CAS. There were no significant differences between emergency and elective CAS in the primary (5.7% vs. 1%, p = 0.161) and secondary (9% vs. 4.8%, p = 0.232) outcomes. We did not find differences in the rate of restenosis/occlusion (7% vs. 11.6%; log-rank test p = 0.3) at a median of 13 months follow-up. Conclusion In our study, emergency CAS in symptomatic patients might have a similar safety and efficacy profile to elective CAS at 3 months and long-term follow-up.

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Clinical Comparison of Outcomes of Early versus Delayed Carotid Artery Stenting for Symptomatic Cerebral Watershed Infarction due to Stenosis of the Proximal Internal Carotid Artery

Cited by 10 publications

References 23 publications

MRI Outcomes Achieved by Simple Flow Blockage Technique in Symptomatic Carotid Artery Stenosis Stenting

MRI Outcomes Achieved by Simple Flow Blockage Technique in Symptomatic Carotid Artery Stenosis Stenting

[Retracted] Safety and Efficacy of Early Carotid Endarterectomy in Patients with Symptomatic Carotid Artery Stenosis: A Meta‐Analysis

Safety and efficacy of symptomatic carotid artery stenting performed in an emergency setting

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