Treatment of acute stroke is time-dependent, with the best outcomes resulting from the earliest interventions. However, for patients with acute ischemic stroke due to a high-grade stenosis of the internal carotid artery, despite maximal medical treatment, an effective intervention to improve their neurologic symptoms and clinical outcome has not yet been established. There are two major concerns: first, cerebral revascularization in the acute stage remains challenging because of the possibility that hemorrhagic infarction or hyperperfusion syndrome will occur after revascularization; second, alarms about carotid artery stenting in patients with acute symptoms are related to the fact that, while with carotid endarterectomy the plaque is completely removed, after stenting it is only remodelled and its stabilization is essential to avoid embolic events during the procedure and in the post-operative period. Although level 1 evidence seems clearly in favor of carotid endarterectomy in symptomatic patients, carotid stenting has been proposed as a possible alternative in selected cases if the procedure is performed in high-volume center with documented low perioperative stroke and death rates. This review summarizes indications and results for carotid artery stenting in recently symptomatic patients.

Setacci, C., DE DONATO, G., Setacci, F., Sirignano, P., Galzerano, G., Borrelli, M.P., et al. (2013). Carotid artery stenting in recently symptomatic patients. JOURNAL OF CARDIOVASCULAR SURGERY, 54, 61-66.

Carotid artery stenting in recently symptomatic patients.

SETACCI, CARLO;DE DONATO, GIANMARCO;BORRELLI, MARIA PIA;CAPPELLI, ALESSANDRO
2013-01-01

Abstract

Treatment of acute stroke is time-dependent, with the best outcomes resulting from the earliest interventions. However, for patients with acute ischemic stroke due to a high-grade stenosis of the internal carotid artery, despite maximal medical treatment, an effective intervention to improve their neurologic symptoms and clinical outcome has not yet been established. There are two major concerns: first, cerebral revascularization in the acute stage remains challenging because of the possibility that hemorrhagic infarction or hyperperfusion syndrome will occur after revascularization; second, alarms about carotid artery stenting in patients with acute symptoms are related to the fact that, while with carotid endarterectomy the plaque is completely removed, after stenting it is only remodelled and its stabilization is essential to avoid embolic events during the procedure and in the post-operative period. Although level 1 evidence seems clearly in favor of carotid endarterectomy in symptomatic patients, carotid stenting has been proposed as a possible alternative in selected cases if the procedure is performed in high-volume center with documented low perioperative stroke and death rates. This review summarizes indications and results for carotid artery stenting in recently symptomatic patients.
Setacci, C., DE DONATO, G., Setacci, F., Sirignano, P., Galzerano, G., Borrelli, M.P., et al. (2013). Carotid artery stenting in recently symptomatic patients. JOURNAL OF CARDIOVASCULAR SURGERY, 54, 61-66.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11365/45615
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