Background: Carotid
revascularization is superior to medical treatment in stroke prevention in
patients with severe symptomatic or asymptomatic atherosclerotic carotid artery
stenosis. However, integrated aggressive medical treatment should be tested
against revascularization. Objective: To compare CAS under protection device with aggressive
medical treatment. Methods: Seventy-five
patients with significant carotid stenosis were divided into three groups;
double antiplatelets (DAP) group (acetyl-salicylic acid 150 mg/day +
clopidogrel 75 mg/day), oral anticoagulation (OAC) group (INR level between
2-2.5 plus acetyl-salicylic acid 150 mg/day) and carotid artery stenting (CAS)
group. All patients were followed for at least 6 months. End point was
ipsilateral transient ischemic attack (TIA), ipsilateral ischemic stroke,
intra-cranial hemorrhage and vascular death. Results: The study was done on two stages. The 2nd
stage decision was based on results of 1st stage (patients who had
new ischemic event on certain modality were shifted to another one). In the 1st
stage, 57 patients were treated conservatively (39 on DAP and 13 on OAC) and 17
patients underwent CAS. CAS group was associated with significantly (p=0.01)
better outcome. Twenty-six (45%) patients of medical group had new ipsilateral
cerebral vascular event, while 2 (12%) patients of CAS group developed new
ipsilateral vascular event (periprocedural TIAs). The 2nd decision
included 29 patients; 22 patients underwent CAS, 5 patients were shifted to OAC
and 2 patients to DAP. Among patients in CAS
group, one (4.5%) developed ischemic stroke while among the 7 patients on
medical management, one patient (14.2%) developed new ischemic stroke. Conclusion: CAS under
protection device is associated with better outcome than aggressive medical
treatment. [Egypt J Neurol
Psychiat Neurosurg. 2013; 50(2): 113-120]
Key
Words: carotid artery stenting, double antiplatelets, oral
anticoagulant.
Correspondence to Hany M Zakieldine, Department of Neurology,
Ain Shams University;
Egypt. Tel.: +201001069930 e-mail: zakieldine.hany@yahoo.com