Carotid Artery Revascularization After Acute Ischemic Stroke: Analysis of a Stroke Center from 2019-2022
Gabriela C Pomales
Mayo Clinic, Jacksonville, FL
OBJECTIVE: The aim of our study was to compare outcomes for carotid revascularization procedures such as carotid endarterectomy (CEA), carotid angioplasty (CA) and carotid artery stenting (CAS) in a cohort of acute ischemic stroke patients.METHODS: A retrospective study of all CEAs, CAs and CASs performed at our institutions from 2019-2022 in patients presenting with an acute ischemic stroke was performed. Outcomes analyzed included recovery from initial event, procedural outcomes, complications, and need for re-intervention on follow-up.RESULTS: 65 (7.6%) patients had a carotid revascularization procedure. Twenty-one (32.3%) were women. Mean age of our patient cohort was 70.9±11.4 years. Forty-seven (72.3%) had CAS, 13 (20.0%) CEA and 6 (9.2%) CAs. At the time of admission, the mean national institute of health stroke scale (NIHSS) was 8.8±8.1. Mean length of hospital stay was 7.1±6.5 days. Mean time from admission to revascularization was 3.5±5.0 days. Revascularization was successful in 93.8% of patients. CAS in 4 (6.2%) patients was unsuccessful due to tortuosity of the carotid artery in two instances, nearly occlusive stenosis with inability to cross the lesion, and extremely firm thrombus in one instance each. Procedural complications occurred in 13 (20%) patients including 4 (6.0%) intracranial hemorrhage, 3 (4.6%) episodes of bradycardia, 2 (3.0%) subarachnoid hemorrhage, 2 (3.0%) brain edema, and one (1.5%) incisional hemorrhage, distal embolization, pneumonia, and acute kidney injury, respectively. At dismissal, the mean modified Rankin Scale (mRS) was 1.6±1.9. Mean NIHSS at follow up was 2.7±3.8 (p<0.0001). Mean follow-up time from index hospitalization was 208.7±185.3 days. Ten (15.4%) patients required re-intervention. The mean time to re-intervention was 261.2±196.3 days. Re-interventions included 6 (9.2%) CAS, 3 (4.6%) CAs and 1 (1.5%) CEA. CONCLUSION: The analysis of our stroke center from 2019-2022 revealed that carotid revascularization occurred in 7.6% of all stroke admissions and this was performed successfully in 93.8% of patients. Most revascularizations were CAS (72.3%); the most common complication was intracranial hemorrhage (6.0%). There was significant improvement of NIHSS on follow-up. 15.4% of patients required re-intervention. Careful surveillance after carotid revascularization is recommended due to the 15.4% risk for re-intervention.
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