Abstract 165: Is Sooner Better When It Comes To Carotid Artery Stenting In Patients With Transient Ischemic Attach (tia) Or Minor Stroke: Prospective Observational Study
Background: Patients with symptomatic carotid artery stenosis presenting with TIA or minor stroke have a risk of recurrent devastating stroke of 21% within 2weeks and 32% within 12 weeks. Efficacy of early endarterectomy (CEA) has already been proven. However, data on ideal timing of Carotid Artery Stenting (CAS) is still lacking.
Methods: A prospective observational cohort of elective endovascular procedures at our hospital was queried for consecutive cases of internal carotid artery stenting for minor symptomatic atherosclerotic stenosis inclusive of the years 2009-2011. A total of 438 patients were studied with the primary outcome measured as a combined incidence of major perioperative complications (stroke, Myocardial Infarction MI or death) at 90 days from procedure time, was compared between patients based on timing of procedure relative to onset of symptoms. Patients were stratified into four treatment groups: those treated urgently (0-2 days), early (3-7 days), routinely (8-14 days), or late (15-90 days). Incidence of the primary outcome was compared between groups using the Fisher’s exact test (SAS software, Cary NC).
Results: Stent implantation was successful in all cases (100%). Combined incidence of major perioperative complications of stroke, MI or death at 90 days was 7% in the urgently treated group 0-2 days (10 out of 143), 11% in the early treated group 3-7 days (10 out of 110), 3% in the routinely treated group 8-14 days (3 out of 100) and 7% in the late treatment group 15-90 days (6 out of 85). Mortality was only reported in the urgently treated group and it was as high as 3% (5 out of 143).
Conclusion: Little data is available regarding urgent carotid stenting post minor stroke or TIA. Out data suggest that the safest period to perform carotid artery stenting in symptomatic atherosclerotic stenosis is between 8-14 days with a rate of all combined major perioperative complications as low as 3%. Randomized and double-blinded trial is warranted to study this further.
- © 2012 by American Heart Association, Inc.