E-140 Single center case studies comprising of early carotid stenting in patients who present with ischemic strokes

IntroductionCarotid artery stenting (CAS) has evolved as an alternative treatment for carotid artery disease. In most patients the indication for carotid intervention has been based on neurological symptoms in combination with the degree of stenosis in the ipsilateral carotid artery.1 Recently, the role of timing of revascularization in the prevention of recurrent stroke in symptomatic patients has gained interest. CREST (Carotid Revascularization Endarterectomy versus Stenting Trial) reported the shortest median interval; this was still 22 days for CEA and 18 days for CAS.2 Because of the high risk of early stroke recurrence after plaque rupture, it is now accepted that intervention offers the greatest benefit when performed soon after the onset of neurological symptoms.MethodsData were analyzed for early carotid stenting, patients who had a stroke as a presenting complaint were only chosen for this study. Thirty cases were identified between Oct 2015 and Feb 2021, that had a stroke and associated with severe carotid disease in the same vascular territory as the stroke. A statistical analysis was performed to reveal interesting data. Out of the 30 patients, 1 patient (3.3%) had an intraparenchymal hemorrhagic conversion in the stroke vascular area, 1 patient (3.3%) had a periprocedural subarachnoid hemorrhage, 1 patient (3.3%) had a reperfusion injury and developed seizures, and 1 patient (3.3%) had a new stroke. The mean time to perform carotid stenting was 2.6 days, median was 2 days.ConclusionEarly carotid stenting should be considered, when waiting 4-6 weeks might not be a feasible option due to high risk of recurrent stroke. The rate of complications is lower than what has been published in case reports and metanalyses in the literature, likely due to improved periprocedural management of platelet activity and blood pressure. Our data suggests that early carotid stenting is feasible and should be considered an option in selected cases. Larger data sets will need to be analyzed to get a clear idea of the overall complication rate.ReferencesDen Hartog, A. G., et al. Delay to carotid endarterectomy in patients with symptomatic carotid artery stenosis. European Journal of Vascular and Endovascular Surgery (2014);47(3):233–239. Brott, Thomas G., et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine 2010;363(1):11–23.DisclosuresS. Bhatt: None. M. Colasurdo: None. K. Raghuram: None.