Stroke in evolutionを呈する急性期頚動脈狭窄症に対する血行再建術

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The efficacy of and indications for urgent carotid endarterectomy (CEA) and carotid artery stenting (CAS) in patients with acute stroke have not been established. The purpose of this study was to retrospectively compare the peri-procedural outcomes and complications of urgent CEA and CAS after acute ischemic stroke in patients with high-grade stenosis of the internal carotid artery at a single center. Urgent CEA was performed for 11 patients (mean age: 66.5±8.0 years, 91% male) and CAS for 25 patients (mean age: 73.4±10 years, 84% male). Neurologic examinations were performed before and after treatment. A decrease of more than four points on the NIHSS score was considered as improvement. Peri-procedural mortality and morbidity of urgent CEA were 0% and 0%, respectively, and those of CAS were also 0% and 0%, respectively. Although the incidence of symptomatic cerebral hyperperfusion after revascularization was 9% in CEA and 4% in CAS, no hemorrhagic transformation was detected. NIHSS improved were 10% in patients who underwent CEA and 40% in patients who underwent CAS. Ten patients (91%) who underwent CEA and 18 patients (72%) who underwent CAS had favorable outcomes (modified Rankin Scale score<3) at 90 days. Urgent CEA and CAS can be performed safely with low peri-procedural mortality and morbidity rates with careful patient selection and peri-operative management.
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