Emergent Carotid Stenting in Acute Stroke Patients WithSteno-Occlusion of Proximal Internal Carotid Artery

J Korean Neurol Assoc > Volume 26(3); 2008 > Article

Journal of the Korean Neurological Association 2008;26(3): 177-185.

내경동맥 근위부의 협착 및 폐쇄에 의한급성 뇌경색 환자에서 응급 경동맥 스텐트술

배기윤, 홍정호 손성일 손철호a 장혁원b

계명대학교 의과대학 신경과학교실, 서울대학교 의과대학 영상의학과학교실a, 계명대학교 의과대학 영상의학과학교실b

Emergent Carotid Stenting in Acute Stroke Patients WithSteno-Occlusion of Proximal Internal Carotid Artery

Gi-Youn Bae

Department of Neurology, Keimyung University School of Medicine, Daegu, Korea; Department of Radiologya, Seoul National University College of Medicine, Seoul, Korea; Department of Radiologyb, Keimyung University School of Medicine, Daegu, Korea

Abstract

Background: The aim of this study was to investigate the feasibility and efficacy of emergent carotid artery stenting (CAS) for occlusion or high-grade stenosis of the internal carotid artery (ICA) in patients with acute ischemic stroke.
Methods: From November 2004 to May 2007, 17 patients admitted to the hospital within 12 hours of symptom onset with occlusion or a high-grade stenosis of the proximal ICA underwent emergent CAS. We analyzed risk factors, imaging findings, functional outcome scales, and peri-procedural complication. The outcome was measured by the modified Rankin scale (mRS) 3 months later and classified into good (mRS score of 0 to 2) or poor (mRS score of 3 to 6).
Results: All patients were recanalized successfully. The median National Institutes of Health Stroke Scale (NIHSS) score was 12.6 (range 4 to 24) just before the emergent CAS, which decreased to 9.4 and 8.2 at 1 day and 7 days after the stenting. Three months later, 12 patients showed good outcome while three had poor outcome and two of them died. Two patients (11.8%) exhibited symptomatic hemorrhagic transformation following the emergent CAS. Smoking status, and initial and immediate post-procedural NIHSS scores were associated with the outcome.
Conclusions: Emergent CAS is a feasible and effective method in acute treatment of selected stroke patients with steno-occlusion of the proximal ICA. KeyWords:Endovascular therapy, Stent, Internal carotid artery, Acute stroke