Emergency stenting to treat neurological complications occurring after carotid endarterectomy

Objectives The purpose of this study was to assess the efficacy of emergenc y stent implantation for the treatment of perioperative stroke after caroti d endarterectomy (CEA). Background Carotid endarterectomy has been proven safe and effective in red ucing the risk of stroke in symptomatic and asymptomatic patients with >60% carotid artery stenosis. However, perioperative stroke has been reported i n 1.5% to 9% of CEA cases. The management of such a complication is challen ging. Recently, percutaneous transluminal carotid angioplasty with stent de ployment has emerged as a valuable and alternative strategy for the treatme nt of carotid artery disease. Methods Between April 1998 and February 2000, 18 of the 995 patients (1.8%) who had CEA in our institution experienced perioperative major or minor ne urological complications. Of these, 13 patients underwent emergency carotid angiogram and eventual stent implantation, whereas the remaining five had surgery re-exploration. Results Carotid angiogram was performed within 20 +/- 10 min and revealed v essel flow-limiting dissection (five cases) or thrombosis (eight cases). Pe rcutaneous transluminal carotid angioplasty with direct stenting (self-expa ndable stent) was performed in all 13 cases. Angiographic success was 100%. Complete remission of neurological symptoms occurred in 11 of the 13 patie nts treated by stent implantation and in one of the five patients treated b y surgical re-exploration (p = 0.024). Conclusions Stent implantation seems to be a safe and effective strategy in the treatment of perioperative stroke complicating CEA, especially when ca rotid dissection represents the main anatomic problem. (J Am Coll Cardiol 2 001;37:2074-9) (C) 2001 by the American College of Cardiology.