Emergency stenting to treat neurological complications occurring after carotid endarterectomy

• Published in: Journal of the American College of Cardiology Vol. 37; no. 8; pp. 2074 - 2079
• Main Authors: Anzuini, Angelo, Briguori, Carlo, Roubin, Gary S, Rosanio, Salvatore, Airoldi, Flavio, Carlino, Mauro, Pagnotta, Paolo, Di Mario, Carlo, Sheiban, Imad, Magnani, Giuseppe, Jannello, Antonio, Melissano, Germano, Chiesa, Roberto, Colombo, Antonio
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-06-2001; Elsevier Science
• Subjects: Aged; Biological and medical sciences; Emergency Medical Services; Endarterectomy, Carotid - adverse effects; Female; Humans; Male; Medical sciences; Middle Aged; Retrospective Studies; Stents; Stroke - etiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; NIH; PTA; TIA; CI; CEA; Human; Endoprosthesis; Nervous system diseases; Stroke; Pathophysiology; Treatment efficiency; Instrumentation therapy; Cardiovascular disease; Stent; Emergency procedure; Cerebral disorder; Vascular disease; Treatment; Surgery; Carotid; Central nervous system disease; Complication; Endarteriectomy; Cerebrovascular disease
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(01)01284-0

OBJECTIVES
The purpose of this study was to assess the efficacy of emergency stent implantation for the treatment of perioperative stroke after carotid endarterectomy (CEA).
BACKGROUND
Carotid endarterectomy has been proven safe and effective in reducing the risk of stroke in symptomatic and asymptomatic patients with >60% carotid artery stenosis. However, perioperative stroke has been reported in 1.5% to 9% of CEA cases. The management of such a complication is challenging. Recently, percutaneous transluminal carotid angioplasty with stent deployment has emerged as a valuable and alternative strategy for the treatment of carotid artery disease.
METHODS
Between April 1998 and February 2000, 18 of the 995 patients (1.8%) who had CEA in our institution experienced perioperative major or minor neurological complications. Of these, 13 patients underwent emergency carotid angiogram and eventual stent implantation, whereas the remaining five had surgery re-exploration.
RESULTS
Carotid angiogram was performed within 20 ± 10 min and revealed vessel flow-limiting dissection (five cases) or thrombosis (eight cases). Percutaneous transluminal carotid angioplasty with direct stenting (self-expandable stent) was performed in all 13 cases. Angiographic success was 100%. Complete remission of neurological symptoms occurred in 11 of the 13 patients treated by stent implantation and in one of the five patients treated by surgical re-exploration (p = 0.024).
CONCLUSIONS
Stent implantation seems to be a safe and effective strategy in the treatment of perioperative stroke complicating CEA, especially when carotid dissection represents the main anatomic problem.