Safety and efficacy of symptomatic carotid artery stenting performed in an emergency setting

Darko Quispe-Orozco*, Kaustubh Limaye, Cynthia B. Zevallos, Mudassir Farooqui, Alan Mendez-Ruiz, Sameer Ansari, Andres Dajles, Edgar A. Samaniego, Colin Derdeyn, Santiago Ortega-Gutierrez

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Carotid artery stenting (CAS) has increasingly emerged as an alternative strategy to carotid endarterectomy in the treatment of patients with symptomatic carotid stenosis. Optimal timing for CAS after symptoms onset remains unclear. We aimed to evaluate the safety and efficacy of CAS when performed in an emergency setting. Patients and methods: We performed a retrospective analysis of CAS patients admitted to our CSC with symptomatic extracranial carotid occlusion or significant stenosis from January 2014-September 2019. Emergency CAS was defined as CAS performed during the same hospitalization from TIA/stroke onset, whereas elective CAS as CAS performed on a subsequent admission. The primary outcome was defined as the occurrence of any stroke, myocardial infarction, or death related to the procedure at 3 months of follow-up. Secondary outcomes included periprocedural complications and the rate of restenosis/occlusion at follow-up. Logistic regression and survival analyses were used to compare outcomes and restenosis at follow-up. Results: We identified 75 emergency and 104 elective CAS patients. Emergency CAS patients had significantly higher rates of ipsilateral carotid occlusion (17% vs. 2%, p < 0.001) and use of general anesthesia (19% vs. 4%, p = 0.001) than elective CAS. There were no significant differences between emergency and elective CAS in the primary (5.7% vs. 1%, p = 0.161) and secondary (9% vs. 4.8%, p = 0.232) outcomes. We did not find differences in the rate of restenosis/occlusion (7% vs. 11.6%; log-rank test p = 0.3) at a median of 13 months follow-up. Conclusion: In our study, emergency CAS in symptomatic patients might have a similar safety and efficacy profile to elective CAS at 3 months and long-term follow-up.

Original languageEnglish (US)
JournalInterventional Neuroradiology
DOIs
StateAccepted/In press - 2020

Keywords

  • Symptomatic carotid artery stenosis
  • carotid artery stenting
  • mechanical thrombectomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Safety and efficacy of symptomatic carotid artery stenting performed in an emergency setting'. Together they form a unique fingerprint.

Cite this