Carotid stenting for progressive cerebral watershed infarction patients with ipsilateral internal carotid stenosis or occlusion

Abstract

Objective To investigate the effectiveness and safety of carotid stenting for progressive cerebral watershed infarction (PCWI) patients with ipsilateral internal carotid stenosis or occlusion during the progressive stage. Methods The clinical data of 23 PCWI patients with ipsilateral internal carotid stenosis or occlusion treated with carotid stenting during the progressive stage were analyzed retrospectively. Among them, 18 were severe internal carotid artery stenosis, and 5 were carotid artery occlusion. Carotid artery stenting were performed in patients with severe internal carotid artery stenosis. The first-stage angioplasty and second-stage stenting were performed in patients with internal carotid artery occlusion. The National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin scale (mRS) were used to evaluate preoperative and postoperative neurologic deficits. Results Twenty-two of 23 patients were stented successfully, the Thrombolysis In Myocardial Infarction (TIMI) flow grade was 3, and the technical success rate was 95.7%. None of the patients demonstrated hyperperfusion in the ipsilateral hemisphere. At day 30 postprocedure, the NHISS scores were significantly improved compared with before procedure (4.41±1.88 vs. 10.00±1.47; t=11.234, P<0.001). The preprocedural TIMI flow grade was 3 in 12 patients (52.2%). Proportion of patients with TIMI flow grade 3 after procedure was significantly increased compared with before procedure (95.7% vs. 52.2%; χ2=11.274, P=0.002). The proportion of patients with mRS scores 0-2 at day 90 after procedure was significantly increased compared with before procedure (69.6% vs. 0%; χ2=24.533, P<0.001). Conclusions Carotid stenting during the progressive stage is safe and it may improve the prognosis in PCWI patients with ipsilateral internal carotid stenosis or occlusion. Key words: Stroke; Brain Ischemia; Disease Progression; Hemodynamics; Carotid Stenosis; Angioplasty; Stents; Treatment Outcome