I would never do carotid stenting, way too many possible complications.
Stents were never the permanent solution, they do nothing to address the inflammation in your arteries that creates plaque. And why would you want to put inflexible stents in flexible arteries? I still don't understand why you would medically need to stent a carotid artery at all if the Circle of Willis is complete. (Unless the whole point is revenue and profit generation) It would seem to make more sense to just close it up and prevent problems from there. My right carotid artery was closed for 10 years and I cognitively functioned quite well with no episodes of fainting.
Here is why your doctor needs to guarantee NO complications from stenting!
stenting (22 posts to May 2011)
carotid stenting (21 posts to May 2016)
carotid artery stenting (7 posts to November 2021)
Restenosis is a gradual re-narrowing of the stented segment that occurs mostly between 3 to 12 months after stent placement.
So by not solving the inflammation problem you get this! Stents don't solve the underlying problem, why the fuck is your doctor prescribing them? Money?
Mediation Analysis of Acute Carotid Stenting in Tandem Lesions
Abstract
Background and Objectives
Current
evidence suggests that acute carotid artery stenting (CAS) for cervical
lesions is associated with better functional outcomes in patients with
acute stroke with tandem lesions (TLs) treated with endovascular therapy
(EVT). However, the underlying causal pathophysiologic mechanism of
this relationship compared with a non-CAS strategy remains unclear. We
aimed to determine whether, and to what degree, reperfusion mediates the
relationship between acute CAS and functional outcome in patients with
TLs.
Methods
This
subanalysis stems from a multicenter retrospective cohort study across
16 stroke centers from January 2015 to December 2020. Patients with
anterior circulation TLs who underwent EVT were included. Successful
reperfusion was defined as a modified Thrombolysis in Cerebral
Infarction scale ≥2B by the local team at each participating center.
Mediation analysis was conducted to examine the potential causal pathway
in which the relationship between acute CAS and functional outcome
(90-day modified Rankin Scale) is mediated by successful reperfusion.
Results
A
total of 570 patients were included, with a median age (interquartile
range) of 68 (59–76), among whom 180 (31.6%) were female. Among these
patients, 354 (62.1%) underwent acute CAS and 244 (47.4%) had a
favorable functional outcome. The remaining 216 (37.9%) patients were in
the non-CAS group. The CAS group had significantly higher rates of
successful reperfusion (91.2% vs 85.1%; p = 0.025) and favorable functional outcomes (52% vs 29%; p
= 0.003) compared with the non-CAS group. Successful reperfusion was a
strong predictor of functional outcome (adjusted common odds ratio
[acOR] 4.88; 95% CI 2.91–8.17; p < 0.001). Successful
reperfusion partially mediated the relationship between acute CAS and
functional outcome, as acute CAS remained significantly associated with
functional outcome after adjustment for successful reperfusion (acOR
1.89; 95% CI 1.27–2.83; p = 0.002). Successful reperfusion explained 25% (95% CI 3%–67%) of the relationship between acute CAS and functional outcome.
Discussion
In
patients with TL undergoing EVT, successful reperfusion predicted
favorable functional outcomes when CAS was performed compared with
non-CAS. A considerable proportion (25%) of the treatment effect of
acute CAS on functional outcome was found to be mediated by improvement
of successful reperfusion rates.
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