Alessandro Rocco1, Fabrizio Sallustio2, Nicola Toschi3, Barbara Rizzato2, Jacopo Legramante4, Arnaldo Ippoliti5, Andrea Ascoli Marchetti5, Enrico Pampana6, Roberto Gandini6, Marina Diomedi7. 1. Stroke Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. Electronic address: a.rocco00@gmail.com. 2. Department of Neuroscience, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. 3. Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. 4. Emergency Department, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. 5. Division of Vascular Surgery, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. 6. Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy and Nuclear Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. 7. Department of Neuroscience, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Santa Lucia Foundation, Rome, Italy.
Abstract
PURPOSE: To compare feasibility, 12-month outcome, and periprocedural and postprocedural risks between carotid artery stent (CAS) placement and carotid endarterectomy (CEA) performed within 1 week after transient ischemic attack (TIA) or mild to severe stroke onset in a single comprehensive stroke center. MATERIALS AND METHODS: Retrospective analysis of prospective data collected from 1,148 patients with ischemic stroke admitted to a single stroke unit between January 2013 and July 2015 was conducted. Among 130 consecutive patients with symptomatic carotid stenosis, 110 (10 with TIA, 100 with stroke) with a National Institutes of Health Stroke Scale (NIHSS) score < 20 and a prestroke modified Rankin Scale (mRS) score < 2 were eligible for CAS placement or CEA and treated according to the preference of the patient or a surrogate. Periprocedural (< 48 h) and postprocedural complications, functional outcome, stroke, and death rate up to 12 months were analyzed. RESULTS: Sixty-two patients were treated with CAS placement and 48 were treated with CEA. Several patients presented with moderate or major stroke (45.8% CEA, 64.5% CAS). NIHSS scores indicated slightly greater severity at onset in patients treated with a CAS vs CEA (6.6 ± 5.7 vs 4.2 ± 3.4; P = .08). Complication rates were similar between groups. mRS scores showed a significant improvement over time and a significant interaction with age in both groups. Similar incidences of death or stroke were shown on survival analysis. A subanalysis in patients with NIHSS scores ≥ 4 showed no differences in complication rate and outcome. CONCLUSIONS: CAS placement and CEA seem to offer early safe and feasible secondary stroke prevention treatments in experienced centers, even after major atherosclerotic stroke.
PURPOSE: To compare feasibility, 12-month outcome, and periprocedural and postprocedural risks between carotid artery stent (CAS) placement and carotid endarterectomy (CEA) performed within 1 week after transient ischemic attack (TIA) or mild to severe stroke onset in a single comprehensive stroke center. MATERIALS AND METHODS: Retrospective analysis of prospective data collected from 1,148 patients with ischemic stroke admitted to a single stroke unit between January 2013 and July 2015 was conducted. Among 130 consecutive patients with symptomatic carotid stenosis, 110 (10 with TIA, 100 with stroke) with a National Institutes of Health Stroke Scale (NIHSS) score < 20 and a prestroke modified Rankin Scale (mRS) score < 2 were eligible for CAS placement or CEA and treated according to the preference of the patient or a surrogate. Periprocedural (< 48 h) and postprocedural complications, functional outcome, stroke, and death rate up to 12 months were analyzed. RESULTS: Sixty-two patients were treated with CAS placement and 48 were treated with CEA. Several patients presented with moderate or major stroke (45.8% CEA, 64.5% CAS). NIHSS scores indicated slightly greater severity at onset in patients treated with a CAS vs CEA (6.6 ± 5.7 vs 4.2 ± 3.4; P = .08). Complication rates were similar between groups. mRS scores showed a significant improvement over time and a significant interaction with age in both groups. Similar incidences of death or stroke were shown on survival analysis. A subanalysis in patients with NIHSS scores ≥ 4 showed no differences in complication rate and outcome. CONCLUSIONS:CAS placement and CEA seem to offer early safe and feasible secondary stroke prevention treatments in experienced centers, even after major atherosclerotic stroke.