Randomized clinical trial comparing neurological outcomes after carotid endarterectomy or stenting

Abstract

NCT01591005 ( http://www.clinicaltrials.gov).

Laboratory-Based Markers as Predictors of Brain Infarction During Carotid Stenting: a Prospective Study

“…In accordance with previous studies [9][10][11] , new ischemic lesions in the brain were defined as hyperintense lesions on postintervention DWI that were not present on pretreatment MRI. Ischemic lesions in the The following variables to determine the possible predictors of new brain ischemia were statistically analyzed: age, gender, laboratory markers, arterial hypertension, diabetes mellitus, coronary heart disease, atrial fibrillation, hyperlipidemia, statin use, smoking, alcohol abuse, occlusion side, severity (%), symptoms of treated ICA stenosis, plaque type and ulceration, time from symptom onset to intervention, duration of intervention, protection use, and severity of contralateral ICA stenosis.…”

“…However, the results of multiplate aggregometry did not differ significantly between patients with and without new ischemic lesions in the brain in the present study. going CAS [9][10][11]29) . These new lesions have been found not only in the ipsilateral hemisphere but also in the contralateral hemisphere or in the posterior circulation [30][31][32] .…”

“…These features have reduced the incidence of postoperative wound problems and injury to the cranial nerve compared with surgery 7,8) . Recent studies have shown carotid endarterectomy and CAS to be associated with a similar prevalence of postoperative death and disabling stroke, but silent infarctions in the brain can be detected more often after CAS [9][10][11] . Atheromatic mass embolization is considered to be the main cause of new infarctions in the brain during CAS as well as local thrombosis with distal embolization caused by the mechanical damage of the endothelium and exposure of procoagulative plaque components 12) .…”

Timing of carotid intervention

“…CREST (Carotid Revascularization Endarterectomy versus Stenting Trial)10 reported the shortest median interval; this was still 22 days for CEA and 18 days for CAS. In all except two RCTs, the mean delay from the index event to revascularization was greater than 1 month9, 12, 14. Even in studies that mostly revascularized sooner after the index event, the mean delay was above the 2‐week threshold3, 10.…”

“…Of the 12 RCTs3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 that have compared carotid endarterectomy (CEA) with carotid artery stenting (CAS) in patients with significant carotid stenosis, only five3, 9, 10, 12, 14 provided information on the time from the index event to revascularization. CREST (Carotid Revascularization Endarterectomy versus Stenting Trial)10 reported the shortest median interval; this was still 22 days for CEA and 18 days for CAS.…”