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Title: Carotid Artery Stenting Helpful in Some With Acute Stroke
Source: [None]
URL Source: http://www.medscape.com/viewarticle/754758
Published: Dec 7, 2011
Author: David Douglas
Post Date: 2011-12-07 06:07:06 by Tatarewicz
Keywords: None
Views: 13

NEW YORK (Reuters Health) Dec 05 - Prompt carotid artery stenting holds promise for stroke patients just as coronary artery stenting does for heart attack patients, a new study suggests.

"Similar to acute myocardial infarction, in which primary stent placement has provided the best treatment outcomes, our study indicates that primary stenting is also feasible for acute atherosclerotic extracranial internal carotid artery (ICA) occlusions and leads to better clinical outcome," Dr. Panagiotis Papanagiotou told Reuters Health by email.

In particular, he said, "In acute stroke patients with large intracranial or extracranial artery occlusions the prognosis is poor with the standard therapy of IV thrombolysis. Therefore immediate endovascular treatment is necessary."

This month in the Journal of the American College of Cardiology, Dr. Papanagiotou of Saarland University Hospital, Homburg, Germany and colleagues review data on 22 patients who had carotid artery stenting within six hours of stroke symptom onset. Four of the patients had an additional intracranial occlusion at the level of the terminal segment of the ICA and 14 had one at the level of the middle cerebral artery.

All but one patient (95%) had successful revascularization of the ICA. There was no acute stent thrombosis. Nine patients (41%) had good clinical outcomes, with a modified Rankin Score of 2 or less at 90 days. Three patients (13.6%) died, all of large infarctions and swelling of the brain in combination with intracranial hemorrhage.

The researchers concluded that the approach is "feasible, safe, and useful." They say the findings support two other small studies which overall have a 91.1% technical success rate and a 45% rate of favorable clinical outcome.

In an editorial, Dr. Christopher J. White of the John Ochsner Heart and Vascular Institute, New Orleans, Louisiana, observes that the findings confirm the "encouraging results for urgent stroke reperfusion therapy with carotid stents."

However, he notes that exploration of such an approach in the U.S. calls for more use stroke team physicians to be versed in carotid artery stenting.

SOURCE: bit.ly/uoyl7m

J Am Coll Cardiol 2011;58:2363-2369.

Poster Comment:

Which means: get to the operating room quickly.

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