Introduction: The aim of present study is to assess safety and efficacy of early CAS in patients with symptomatic carotid artery stenosis compared with delayed CAS
Methods: Treatment outcomes of CAS in 156 patients with symptomatic carotid stenosis in single institute from May 2003 to March 2010 were analyzed. Patients were divided into early and delayed group by the time interval from the last ischemic attack to CAS. Early group is symptomatic patient group who underwent CAS within 2 weeks after the last ischemic attack. Fifty-eight patients were included in the early group and 101 CASs in the delayed group. We compared two groups in terms of procedural complication and any ipsilateral stroke or death at 30 days and 365 days after CAS.
Results: There was no difference in periprocedural complication between early and delayed groups. Procedural complications occurred in 5 cases (8.6%) in early group and 8 cases (7.9%) in delayed group (p=1.000). However, there was definite difference in any ipsilateral stroke or death at 30 days and 365 days after CAS. The 30-day any ipsilateral stroke or death rate was 10.3% (6 patients) in early group, but 2% (2 patients) in delayed group (HR=5.712, p=0.037). Also, the 365-day any ipsilateral stroke or death rate was 17.2% (10 patients) in early group, but 3% (3 patients) in delayed group (HR=6.806, p=0.005).
Conclusions: In early CAS group, the risk of the 1-year outcome of stroke or death was significantly higher than that of delayed group. The early CAS appears to a dangerous procedure in carotid artery stenosis patients with acute neurologic symptoms.
Patient Care: Now, the timing of carotid artery stenting have no recommandation.
In the future, the treatment options will be established for the acute symptomatic carotid artery stenosis patient
Learning Objectives: 1) The carotid stenting is different with Carotid endarterectomy
2) it may be a dangerous concept to apply the same early treatment timing policy as CEA for CAS for symptomatic carotid stenosis