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Original research
Early carotid angioplasty and stenting may offer non-inferior treatment for symptomatic cases of carotid artery stenosis
  1. Michael M Wach1,2,
  2. Travis M Dumont1,2,
  3. Maxim Mokin1,2,
  4. Tareq Kass-Hout3,4,
  5. Kenneth V Snyder1,2,3,5,6,
  6. L Nelson Hopkins1,2,5,6,7,
  7. Elad I Levy1,2,5,6,
  8. Adnan H Siddiqui1,2,5,6
  1. 1Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA
  2. 2Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
  3. 3Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York, USA
  4. 4Department of Neurology, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
  5. 5Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA
  6. 6Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
  7. 7Jacobs Institute, Buffalo, New York, USA
  1. Correspondence to Dr Adnan H Siddiqui, University at Buffalo Neurosurgery, 100 High Street, Suite 4, Buffalo, NY 14203, USA; asiddiqui{at}ubns.com

Abstract

Objective Early intervention is desirable in patients presenting with stroke or transient ischemic attack (TIA) referable to carotid artery stenosis because of the high incidence of recurrent ischemic events within 48 h post-ictus. However, the optimal timing of performing carotid angioplasty and stenting (CAS) in these patients remains unclear amid concerns for an elevated risk of perioperative complications. The primary outcome of this study was the combined incidence of major perioperative complications (stroke, myocardial infarction (MI), death) based on timing of CAS relative to symptom onset.

Methods A prospectively maintained database of all neuroendovascular procedures at our hospital was searched for consecutive cases of extracranial internal CAS procedures performed for symptomatic atherosclerotic carotid stenosis between January 2009 and January 2012. Rates of perioperative complications including 30-day stroke, MI and death were assembled in a total of 221 patients.

Results The primary outcome was not statistically different among groups stratified based on intervention timing, with a combined incidence of stroke, MI or death of 7.1% in patients treated within 2 days, 4.5% in patients treated between days 3 and 7, 2.8% in patients treated between days 8 and 14 and 3.7% in patients treated between days 15 and 90 (p=0.749, Fisher exact test).

Conclusions Our results support the conclusion that early CAS (within 2 days) carries no additional risks compared with CAS after 2 days or any other timing of the intervention up to 90 days. Early CAS may represent a reasonable option for acute revascularization to minimize the risk of perioperative stroke and overall perioperative complications.

  • Angioplasty
  • Stent
  • Stenosis
  • Cervical

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