Assessment of Endovascular Management of Extracranial Internal Carotid Artery Stenosis

Abstract

Background: carotid artery stenting (CAS) had become widely used as an alternative to carotid endarterectomy (CEA) in revascularization therapy of carotid artery stenosis, especially in some high risk patients for surgical intervention. Objective: the purpose of this study was to evaluate the outcome and follow up of cases that undergo extracranial CAS at the Neuroendovascular Unit of Ain Shams University Hospital. Methods: during a 30 month period, 50 cases were enrolled and underwent carotid artery stenting with open cell (Protege® - EV3) or closed cell (Wall stent® - Boston scientific) stents. A filter device for embolic protection (Spider filter® - EV3) was used. Clinical assessment with the National Institute of Health Stroke Scale (NIHSS) together with post procedural diffusion-weighted magnetic resonance imaging (DW-MRI) was used to determine cerebral embolization. Results: CAS was performed in 50 cases; 40 (80%) symptomatic and 10 (20%) asymptomatic . A similar number of open-cell and closed-cell stents were used. New acute cerebral emboli were detected with DW-MRI in 12% (6/50) of cases after the procedure. Three (3/50) cases (6%) showed corresponding clinical deterioration in NIHSS; two cases developed minor stroke and the third case developed a major stroke. Conclusion: CAS at Ain Shams Neuroendovascular Unit showed a high technical success rate and good short term clinical outcome.