Usefulness of Early Stenting for Symptomatic Extracranial Carotid Stenosis

Background While carotid angioplasty and stenting (CAS) have become an established procedure, outcomes of early CAS for symptomatic extracranial carotid stenosis (SECS) remain poorly understood. The present study aimed at determining the effectiveness of early CAS in SECS. Methods Herein, 224 SECS patients underwent elective CAS between January 2008 and June 2015. The study population was stratified based on the time from symptom onset to the procedure (early CAS group: within 14 days; delayed CAS group: later than 14 days). Subgroup analysis (chi-square test, Mantel-Haenszel chi-square test, and analysis of covariance) evaluated the demographics, incidence of periprocedural thromboembolic complications, cerebral hyperperfusion syndrome (CHS), intracranial bleeding, and treatment outcomes on the modified Rankin Scale (mRS). Results Symptomatic thromboembolic complications and CHS were noted in 2.68% and 0.89% of patients, respectively. The initial National Institutes of Health Stroke Scale (NIHSS) score was significantly higher in patients who underwent early CAS than in those who underwent delayed CAS (2.50 ± 3.97 vs. 0.97 ± 2.08, P = 0.001). After adjusting for age, duration of preprocedural dual antiplatelet therapy, initial NIHSS score, and preprocedural NIHSS score, the groups did not differ significantly regarding the incidence of symptomatic thromboembolic complications (P = 0.195), incidence of CHS (P = 0.950), incidence of intracranial bleeding (P = 0.970), 30-day mRS score (P = 0.124), and mRS score at final follow-up (P = 0.132). Conclusions For SECS patients who cannot undergo early carotid endarterectomy, early CAS is effective and safe if selectively indicated considering disease severity. Early and delayed CAS provide comparable mRS scores, incidence of symptomatic thromboembolic complications, CHS, and intracranial bleeding.