Carotid Artery Stenosis with Acute Ischemic Stroke: Stenting Versus Angioplasty

Overview

Journal J Vasc Interv Neurol

Date 2015 Nov 25

PMID 26600924

Citations 4

Authors

Mark R Villwock

David J Padalino

Eric M Deshaies

Affiliations

Soon will be listed here.

Abstract

Background: When a patient with carotid artery stenosis presents emergently with acute ischemic stroke, the optimum treatment plan is not clearly defined. If intervention is warranted, and open surgery is prohibitive, endovascular revascularization may be performed. The use of stents places the patient at additional risk due to their thrombogenic potential. The intent of this study was to compare outcomes following endovascular approaches (angioplasty alone vs. stent) in the setting of acute stroke.

Methods: We extracted a population from the National Inpatient Sample (2012) and the Nationwide Inpatient Sample (2003-2011) composed of patients with carotid artery stenosis with infarction that were admitted nonelectively and received endovascular revascularization. Patients treated with mechanical thrombectomy or thrombolysis were excluded. Categorical variables were compared between treatment groups with Chi-squared tests. Binary logistic regression was performed to evaluate mortality and iatrogenic stroke while controlling for age, case severity, and comorbidity burden.

Results: About 6,333 admissions met our criteria. A majority were treated via stenting (89%, n = 5,608). The angioplasty-alone group had significantly higher mortality (9.0% vs. 3.8%, p < 0.001) and iatrogenic stroke rate (3.9% vs. 1.9%, p < 0.001) than the stent group. The adjusted odds ratios of mortality and iatrogenic stroke for patients treated with angioplasty alone were 1.953 (p < 0.001) and 1.451 (p = 0.105), respectively, in comparison to patients treated with carotid stenting.

Conclusion: Multivariate analysis found the risk of mortality to be elevated following angioplasty alone. This may represent selection bias, but it also may indicate that symptomatic patients with stroke suffer from severe stenosis and unstable plaques that would benefit from stent placement. These results would caution angioplasty alone as an arm of a future randomized trial involving this severely burdened patient population requiring urgent intervention.

Citing Articles

A Case of Intravascular Treatment for Acute Ischemic Stroke with Internal Carotid Artery Stenosis That Developed While Driving.

Oyama Y, Miyamoto M, Onuki T, Uno T, Ito A, Yamane F J Neuroendovasc Ther. 2023; 14(8):313-318.

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Treatment Strategies for Tandem Occlusions in Acute Ischemic Stroke.

Gemmete J, Wilseck Z, Pandey A, Chaudhary N Semin Intervent Radiol. 2020; 37(2):207-213.

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Evaluation of spatial distribution and characterization of wall shear stress in carotid sinus based on two-dimensional color Doppler imaging.

Zhang B, Ma Y, Ding F Biomed Eng Online. 2018; 17(1):141.

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Clinical Comparison of Outcomes of Early versus Delayed Carotid Artery Stenting for Symptomatic Cerebral Watershed Infarction due to Stenosis of the Proximal Internal Carotid Artery.

Liu H, Chu J, Zhang L, Liu C, Yan Z, Zhou S Biomed Res Int. 2016; 2016:6241546.

PMID: 28004005 PMC: 5149605. DOI: 10.1155/2016/6241546.

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