Emergency Carotid Artery Stent Insertion for Acute ICA Occlusion
Objective : An effective intervention has not yet been established for patients with acute occlusion of the internal carotid artery (ICA). The aim of our study was to investigate the feasibility, safety, and efficacy of emergent stent placement of carotid artery to improve neurologic symptoms and clinical outcome. Methods : Of 84 consecutive patients with severe ICA stenosis who were admitted to our institution from March 2006 to May 2009, 10 patients with acute ICA occlusion (11.9%) underwent emergency carotid artery stent placement. We reviewed their records for neurologic outcome using the National Institutes of Health Stroke Scale (NIHSS) score, before and at 7 days after stent placement; clinical outcome using the modified Rankin Scale score (mRS) and Glasgow Outcome Scale (GOS); frequency of procedure-related complications; and recurrence rate of ipsilateral ischemic stroke within 90 days. Results : Carotid lesions were dilated completely in all patients. Median NIHSS scores before emergency stent placement and at 7 days were 16.6 and 6, respectively, showing significant improvement. Eight patients (80%) had favorable outcomes (mRS score 0-2 and GOS 4-5). Complications occurred in two patients (20%): stent insertion failed in one and an intracerebral hemorrhage occurred in the other. Ipsilateral ischemic stroke did not recur within 3 months. Conclusion : Emergency carotid artery stent placement can improve the 7-day neurologic outcome and the 90-day clinical outcome in selected patients with acute cerebral infarction.
- Eckstein HH, Schumacher H, Klemm K, Laubach H, Kraus T, Ringleb P, et al. : Emergency carotid endarterectomy. Cerebrovasc Dis 9 : 270-281, 1999
- Ferguson GG, Eliasziw M, Barr HW, Clagett GP, Barnes RW, Wallace MC, et al. : The North American Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients. Stroke 30 : 1751-1758, 1999
- Geisler BS, Rother J, Kucinski T, Zeumer H, Eckert B : Emergency carotid artery stenting in persistent hemodynamic deficit associated with severe carotid stenosis. AJNR Am J Neuroradiol 26 : 549-552, 2005
- Groschel K, Knauth M, Ernemann U, Pilgram SM, Schnaudigel S, Kastrup A : Early treatment after a symptomatic event is not associated with an increased risk of stroke in patients undergoing carotid stenting. Eur J Neurol 15 : 2-5, 2008
- Hoppe H, Barnwell SL, Nesbit GM, Petersen BD : Stent-grafts in the treatment of emergent or urgent carotid artery disease : review of 25 cases. J Vasc Interv Radiol 19 : 31-41, 2008
- Imai K, Mori T, Izumoto H, Watanabe M, Majima K : Emergency carotid artery stent placement in patients with acute ischemic stroke. AJNR Am J Neuroradiol 26 : 1249-1258, 2005
- Jahromi BS, Tummala RP, Yamamoto J, Levy EI, Siddiqui AH, Hopkins LN : Early carotid stenting for symptomatic stenosis and intraluminal thrombus presenting with stroke. Neurology 71 : 1831-1833, 2008
- Meyer FB, Sundt TM Jr, Piepgras DG, Sandok BA, Forbes G : Emergency carotid endarterectomy for patients with acute carotid occlusion and profound neurological deficits. Ann Surg 203 : 82-89, 1986
- Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T, et al. : Guidelines for carotid endarterectomy. A multidisci-plinary consensus statement from the ad hoc Committee, American Heart Association. Stroke 26 : 188-201, 1995
- Naylor AR : Delay may reduce procedural risk, but at what price to the patient? Eur J Vasc Endovasc Surg 35 : 383-391, 2008
- Papanagiotou P, Roth C, Grunwald IQ, Ahlhelm F, Ernst N, Haass A, et al. : [Carotid artery stenting for acute stroke.] Radiologe 49 : 335-339, 2009
- Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ; Carotid Endarterectomy Trialists Collaboration : Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 363 : 915-924, 2004
- Setacci C, de Donato G, Chisci E, Setacci F : Carotid Artery Stenting in Recently Symptomatic Patients : a single center experience. Ann Vasc Surg 24 : 474-479, 2010
- Setacci C, de Donato G, Chisci E, Setacci F : Rationale and design of emergent/urgent carotid artery stenting (EUCAS) registry. J Cardiovasc Surg (Torino) 49 : 737-742, 2008
- Wholey MH, Wholey M, Mathias K, Roubin GS, Diethrich EB, Henry M, et al. : Global experience in cervical carotid artery stent placement. Catheter Cardiovasc Interv 50 : 160-167, 2000
- Wholey MH, Wu WC : Current status in cervical carotid artery stent placement. J Cardiovasc Surg 50 : 29-37, 2009
- Zhou W, Dinishak D, Lane B, Hernandez-Boussard T, Bech F, Rosen A : Long-term radiographic outcomes of microemboli following carotid interventions. J Vasc Surg 50 : 1314-1319, 2009
- Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 325 : 445-453, 1991
- Mussa FF, Aaronson N, Lamparello PJ, Maldonado TS, Cayne NS, Adelman MA, et al. : Outcome of carotid endarterectomy for acute neurological deficit. Vasc Endovascular Surg 43 : 364-369, 2009
- Wholey MH, Wholey MH, Jarmolowski CR, Eles G, Levy D, Buecthel J : Endovascular stents for carotid occlusive disease. J Endovasc Surg 4 : 326-338, 1997
저자의 다른 논문
- 2008 "Effect of Vagus Nerve Stimulation in Post-Traumatic Epilepsy and Failed Epilepsy Surgery : Preliminary Report" Journal of Korean Neurosurgical Society = 대한신경외과학회지 44 (4): 196~198
- 2008 "Midline Glioblastoma Multiforme With Bilateral Symmetric Cysts" Journal of Korean Neurosurgical Society = 대한신경외과학회지 43 (2): 105~108
- 2011 "Diagnostic Usefulness of High Resolution Cross Sectional MRI in Symptomatic Middle Cerabral Arterial Dissection" Journal of Korean Neurosurgical Society = 대한신경외과학회지 49 (6): 370~372
- Synapse : 저널
유료 다운로드의 경우 해당 사이트의 정책에 따라 신규 회원가입, 로그인, 유료 구매 등이 필요할 수 있습니다. 해당 사이트에서 발생하는 귀하의 모든 정보활동은 NDSL의 서비스 정책과 무관합니다.
원문복사신청을 하시면, 일부 해외 인쇄학술지의 경우 외국학술지지원센터(FRIC)에서
무료 원문복사 서비스를 제공합니다.
NDSL에서는 해당 원문을 복사서비스하고 있습니다. 위의 원문복사신청 또는 장바구니 담기를 통하여 원문복사서비스 이용이 가능합니다.
- 이 논문과 함께 출판된 논문 + 더보기