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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(03): 212-218
DOI: 10.1590/0004-282X20150213
ARTICLE

Carotid artery stenting in the context of endovascular treatment of acute ischemic stroke

Angioplastia com stent de carótida no contexto do tratamento endovascular do acidente vascular cerebral isquêmico agudo

Authors

  • Adson F. de Lucena

    1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista, Ribeirao Preto SP, Brazil;

  • Luís Henrique de Castro-Afonso

    1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista, Ribeirao Preto SP, Brazil;

  • Lucas M. Monsignore

    1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista, Ribeirao Preto SP, Brazil;

  • Guilherme S. Nakiri

    1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista, Ribeirao Preto SP, Brazil;

  • Soraia R. C. Fábio

    2   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurologia, Ribeirao Preto SP, Brazil.

  • Octávio Pontes Neto

    2   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurologia, Ribeirao Preto SP, Brazil.

  • Daniel Giansante Abud

    1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista, Ribeirao Preto SP, Brazil;

Support: Pontes-Neto FAPESP 2012/51725-2.
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ABSTRACT

Mechanical thrombectomy as an adjunctive to intravenous thrombolysis is now the standard treatment for acute ischemic stroke (AIS) due to large vessel occlusions. However, the best management of acute carotid tandem occlusions (CTO) remains controversial.

Method Twenty patients underwent endovascular treatment of acute CTO. The primary endpoint was the composite rate of complete or partial recanalization without a symptomatic intracranial hemorrhage (sICH). Secondary endpoints were recanalization times, procedure times, and clinical outcomes at three months.

Results The primary endpoint was reached in 17 (85%) patients. Recanalization rate was reached in 90% of patients (19/20) and sICH rate was 5% (1/20). At the 3-month follow-up we obtained a mRS ≤ 2 rate of 35% (7/20) and a mortality rate of 20% (4/20).

Conclusion Carotid angioplasty stenting and endovascular treatment of AIS due to CTO appears effective with an acceptable rate of sICH.

RESUMO

Trombectomia mecânica com stentrievers associada a trombólise endovenosa com rTPA é o tratamento padrão-ouro do acidente vascular cerebral isquêmico agudo (AVCi) devido à oclusões de grandes vasos. No entanto, a melhor estratégia terapêutica para oclusões carotídeas combinadas ainda permanece controversa.

Método Vinte paciente receberam tratamento endovascular. O desfecho primário foi a taxa de recanalização completa sem sangramento intracraniano sintomático. Os desfechos secundários foram os tempos de recanalização, duração dos procedimentos e desfechos clínicos em 3 meses.

Resultados O desfecho primário foi alcançado em 17 (85%) pacientes. A taxa de recanalização foi de 90% (19/20) e a taxa de HIS foi de 5% (1/20). Em três meses, foi obtido bom desfecho neurológico em 35% (7/20) dos pacientes e a mortalidade foi de 20% (4/20).

Conclusão A angioplastia com stent de carotída associada ao tratamento endovascular para oclusões combinadas agudas de carótida parece ser efetiva sem um aumento de HIS.

acute ischemic stroke - symptomatic carotid artery stenosis - carotid angioplasty stenting
acidente vascular cerebral isquêmico agudo - estenose carotídea sintomática - angiolastia com stent de carótida

Support:

Support: Pontes-Neto FAPESP 2012/51725-2.




Publication History

Received: 01 June 2015

Accepted: 09 November 2015

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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