Journal of Korean Neurosurgical Society

  • 제47권6호
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  • Pages.428-432
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  • 2010
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Emergency Carotid Artery Stent Insertion for Acute ICA Occlusion

  • Lee, Hai-Ong (Department of Neurosurgery, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital) ;
  • Koh, Eun-Jeong (Department of Neurosurgery, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital) ;
  • Choi, Ha-Young (Department of Neurosurgery, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital)
  • 투고 : 2010.04.05
  • 심사 : 2010.05.23
  • 발행 : 2010.06.28
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초록

Objective : An effective intervention has not yet been established for patients with acute occlusion of the internal carotid artery (ICA). The aim of our study was to investigate the feasibility, safety, and efficacy of emergent stent placement of carotid artery to improve neurologic symptoms and clinical outcome. Methods : Of 84 consecutive patients with severe ICA stenosis who were admitted to our institution from March 2006 to May 2009, 10 patients with acute ICA occlusion (11.9%) underwent emergency carotid artery stent placement. We reviewed their records for neurologic outcome using the National Institutes of Health Stroke Scale (NIHSS) score, before and at 7 days after stent placement; clinical outcome using the modified Rankin Scale score (mRS) and Glasgow Outcome Scale (GOS); frequency of procedure-related complications; and recurrence rate of ipsilateral ischemic stroke within 90 days. Results : Carotid lesions were dilated completely in all patients. Median NIHSS scores before emergency stent placement and at 7 days were 16.6 and 6, respectively, showing significant improvement. Eight patients (80%) had favorable outcomes (mRS score 0-2 and GOS 4-5). Complications occurred in two patients (20%): stent insertion failed in one and an intracerebral hemorrhage occurred in the other. Ipsilateral ischemic stroke did not recur within 3 months. Conclusion : Emergency carotid artery stent placement can improve the 7-day neurologic outcome and the 90-day clinical outcome in selected patients with acute cerebral infarction.

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참고문헌

  1. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 325 : 445-453, 1991 https://doi.org/10.1056/NEJM199108153250701
  2. Eckstein HH, Schumacher H, Klemm K, Laubach H, Kraus T, Ringleb P, et al. : Emergency carotid endarterectomy. Cerebrovasc Dis 9 : 270-281, 1999 https://doi.org/10.1159/000015978
  3. Ferguson GG, Eliasziw M, Barr HW, Clagett GP, Barnes RW, Wallace MC, et al. : The North American Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients. Stroke 30 : 1751-1758, 1999 https://doi.org/10.1161/01.STR.30.9.1751
  4. Geisler BS, Röther J, Kucinski T, Zeumer H, Eckert B : Emergency carotid artery stenting in persistent hemodynamic deficit associated with severe carotid stenosis. AJNR Am J Neuroradiol 26 : 549-552, 2005
  5. Groschel K, Knauth M, Ernemann U, Pilgram SM, Schnaudigel S, Kastrup A : Early treatment after a symptomatic event is not associated with an increased risk of stroke in patients undergoing carotid stenting. Eur J Neurol 15 : 2-5, 2008 https://doi.org/10.1111/j.1468-1331.2008.02212.x
  6. Hoppe H, Barnwell SL, Nesbit GM, Petersen BD : Stent-grafts in the treatment of emergent or urgent carotid artery disease : review of 25 cases. J Vasc Interv Radiol 19 : 31-41, 2008 https://doi.org/10.1016/j.jvir.2007.08.024
  7. Imai K, Mori T, Izumoto H, Watanabe M, Majima K : Emergency carotid artery stent placement in patients with acute ischemic stroke. AJNR Am J Neuroradiol 26 : 1249-1258, 2005
  8. Jahromi BS, Tummala RP, Yamamoto J, Levy EI, Siddiqui AH, Hopkins LN : Early carotid stenting for symptomatic stenosis and intraluminal thrombus presenting with stroke. Neurology 71 : 1831-1833, 2008 https://doi.org/10.1212/01.wnl.0000339379.15449.65
  9. Meyer FB, Sundt TM Jr, Piepgras DG, Sandok BA, Forbes G : Emergency carotid endarterectomy for patients with acute carotid occlusion and profound neurological deficits. Ann Surg 203 : 82-89, 1986 https://doi.org/10.1097/00000658-198601000-00014
  10. Mussa FF, Aaronson N, Lamparello PJ, Maldonado TS, Cayne NS, Adelman MA, et al. : Outcome of carotid endarterectomy for acute neurological deficit. Vasc Endovascular Surg 43 : 364-369, 2009 https://doi.org/10.1177/1538574409335276
  11. Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T, et al. : Guidelines for carotid endarterectomy. A multidisci-plinary consensus statement from the ad hoc Committee, American Heart Association. Stroke 26 : 188-201, 1995 https://doi.org/10.1161/01.STR.26.1.188
  12. Naylor AR : Delay may reduce procedural risk, but at what price to the patient? Eur J Vasc Endovasc Surg 35 : 383-391, 2008 https://doi.org/10.1016/j.ejvs.2008.01.002
  13. Papanagiotou P, Roth C, Grunwald IQ, Ahlhelm F, Ernst N, Haass A, et al. : [Carotid artery stenting for acute stroke.] Radiologe 49 : 335-339, 2009 https://doi.org/10.1007/s00117-008-1775-x
  14. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ; Carotid Endarterectomy Trialists Collaboration : Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 363 : 915-924, 2004 https://doi.org/10.1016/S0140-6736(04)15785-1
  15. Setacci C, de Donato G, Chisci E, Setacci F : Carotid Artery Stenting in Recently Symptomatic Patients : a single center experience. Ann Vasc Surg 24 : 474-479, 2010 https://doi.org/10.1016/j.avsg.2009.07.022
  16. Setacci C, de Donato G, Chisci E, Setacci F : Rationale and design of emergent/urgent carotid artery stenting (EUCAS) registry. J Cardiovasc Surg (Torino) 49 : 737-742, 2008
  17. Wholey MH, Wholey MH, Jarmolowski CR, Eles G, Levy D, Buecthel J : Endovascular stents for carotid occlusive disease. J Endovasc Surg 4 : 326-338, 1997 https://doi.org/10.1583/1074-6218(1997)004<0326:ESFCAO>2.0.CO;2
  18. Wholey MH, Wholey M, Mathias K, Roubin GS, Diethrich EB, Henry M, et al. : Global experience in cervical carotid artery stent placement. Catheter Cardiovasc Interv 50 : 160-167, 2000 https://doi.org/10.1002/(SICI)1522-726X(200006)50:2<160::AID-CCD2>3.0.CO;2-E
  19. Wholey MH, Wu WC : Current status in cervical carotid artery stent placement. J Cardiovasc Surg 50 : 29-37, 2009
  20. Zhou W, Dinishak D, Lane B, Hernandez-Boussard T, Bech F, Rosen A : Long-term radiographic outcomes of microemboli following carotid interventions. J Vasc Surg 50 : 1314-1319, 2009 https://doi.org/10.1016/j.jvs.2009.07.105

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  7. Acute carotid artery stenting in symptomatic high-grade cervical carotid artery stenosis vol.40, pp.1, 2010, https://doi.org/10.1007/s10143-016-0737-4
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  9. Outcomes of early carotid stenting and angioplasty in large-vessel anterior circulation strokes treated with mechanical thrombectomy and intravenous thrombolytics vol.24, pp.4, 2018, https://doi.org/10.1177/1591019918768574
  10. Acute symptomatic extracranial internal carotid occlusion - natural course and clinical impact vol.49, pp.1, 2010, https://doi.org/10.1024/0301-1526/a000826