Early carotid artery stenting after onset neurologic symptoms |
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| Institution: | 1. Department of Surgery, Unit of Vascular and Endovascular Surgery, University of Siena, Viale Bracci, 53100 Siena Siena, Italy;2. Department of Vascular Surgery, Casa di Cura Giovanni XXIII, Monastier di Treviso, Italy;3. Department of Vascular Surgery, University Roma La Sapienza, Rome, Italy;1. Unit of Vascular and Endovascular Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy;2. Unit of Radiology, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy;1. Core Evaluation Services, Weatherford Laboratories, Av. Antimonio s/n, 86010, Villahermosa, Tabasco, Mexico;2. Departament de Mineralogia, Petrologia i Geologia Aplicada, Facultat de Ciències de la Terra, Universitat de Barcelona, Martí i Franquès s/n, 08028, Barcelona, Spain;3. Departament de Dinàmica de la Terra i l''Oceà, Facultat de Ciències de la Terra, Universitat de Barcelona, Martí i Franquès s/n, 08028, Barcelona, Spain;1. Cardiac Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy;2. Department of Pediatric Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy |
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| Abstract: | Multicenter clinical trials level 1 evidence favors the application of carotid endarterectomy in symptomatic patients, especially the in the elderly cohort. Carotid artery stenting has been proposed as a possible early alternative in selected patients after onset of ipsilateral neurologic symptoms. It is well known that treatment of acute stroke is time-dependent in patients with acute ischemic stroke caused by high-grade stenosis of the internal carotid artery, but intensive medical treatment in conjunction with intervention to improve stroke severity and clinical outcomes has not been established. Two major clinical concerns exist: (1) the risk of hemorrhagic infarction after cerebral revascularization in the acute stage and (2) application of carotid stenting in the acute embolic stage, which may be associated with continued embolic risk after carotid artery stenting compared to carotid endarterectomy, which removes the symptomatic plaque. This review summarizes the indications and results of early carotid artery stenting after onset of neurologic symptoms, considering the new carotid stents and cerebral protection systems available for clinical use and enhanced stenting techniques. |
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