Safety and efficacy of symptomatic carotid artery stenting performed in an emergency setting

I would think this whole problem could be eliminated by:

1. Determining if the Circle of Willis is complete.

2. If yes, then close the artery off to prevent ANY POSSIBILITY of clots breaking off and traveling to the brain.

3. This prevents stent placement complications per European Society of Cardiology

A - Minor complications

• Carotid artery spasm
• Sustained hypotension / bradycardia
• Carotid artery dissection
• Contrast encephalopathy (very rare)
• Minor embolic neurological events (TIAs)

B - Major complications

• Major embolic stroke
• Intracranial hemorrhage
• Hyperperfusion syndrome
• Carotid perforation (very rare)
• Acute stent thrombosis (very rare)
• Complications at the site of the vascular access

Don't listen to me, I'm not medically trained and I don't have a Dr. in front of my name.  But pepper your doctor with lots of questions, including GUARANTEEING NO PROBLEMS. Why would you want to place an inflexible stent in a flexible artery? Hell, my right carotid artery was 80% blocked at time of stroke which my doctors never found so luckily they didn't try to stent me. It eventually completely closed on its own with absolutely no cognitive problems encountered.

Don't listen to what I have to say, I'm not medically trained.

The latest here:

Safety and efficacy of symptomatic carotid artery stenting performed in an emergency setting

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Darko Quispe-Orozco*, Kaustubh Limaye*, Cynthia B Zevallos, ...

First Published December 6, 2020 Research Article 

https://doi.org/10.1177/1591019920977552

Article information

Abstract

Introduction

Carotid artery stenting (CAS) has increasingly emerged as an alternative strategy to carotid endarterectomy in the treatment of patients with symptomatic carotid stenosis. Optimal timing for CAS after symptoms onset remains unclear. We aimed to evaluate the safety and efficacy of CAS when performed in an emergency setting.

Patients and methods

We performed a retrospective analysis of CAS patients admitted to our CSC with symptomatic extracranial carotid occlusion or significant stenosis from January 2014-September 2019. Emergency CAS was defined as CAS performed during the same hospitalization from TIA/stroke onset, whereas elective CAS as CAS performed on a subsequent admission. The primary outcome was defined as the occurrence of any stroke, myocardial infarction, or death related to the procedure at 3 months of follow-up. Secondary outcomes included periprocedural complications and the rate of restenosis/occlusion at follow-up. Logistic regression and survival analyses were used to compare outcomes and restenosis at follow-up.

Results

We identified 75 emergency and 104 elective CAS patients. Emergency CAS patients had significantly higher rates of ipsilateral carotid occlusion (17% vs. 2%, p < 0.001) and use of general anesthesia (19% vs. 4%, p = 0.001) than elective CAS. There were no significant differences between emergency and elective CAS in the primary (5.7% vs. 1%, p = 0.161) and secondary (9% vs. 4.8%, p = 0.232) outcomes. We did not find differences in the rate of restenosis/occlusion (7% vs. 11.6%; log-rank test p = 0.3) at a median of 13 months follow-up.

Conclusion

In our study, emergency CAS in symptomatic patients might have a similar safety and efficacy profile to elective CAS at 3 months and long-term follow-up.

Keywords Symptomatic carotid artery stenosis, mechanical thrombectomy, carotid artery stenting.

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