London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 841 936 Interventional neurology Carotid stenting and endarterectomy as complementary therapies for stroke prevention in pa-tients with extracranial carotid artery disease A.V. Khripun1, M.V. Malevannyi2, Ya.V. Kulikovskikh3 Regional vascular center, Rostov-on-Don, RUSSIAN FEDERATION1, Regional vascular center, Rostov-on-Don, RUSSIAN FEDERATION2, Regional vascular center, Rostov-on-Don, RUSSIAN FEDERATION3 Background: today the carotid stenting and endarterectomy are recognized as equal in management of carotid artery disease but they continue to be actively opposed to each other with no focus on the fact that each method has its limitations determining an increased risk of intervention. Methods: a retrospective analysis of treatment of 340 patients with carotid disease during the peri-od from 2007 to 2011 was performed. All patients were divided into the carotid stenting group (170 patients: 69.2±8.9 years, 65.3% symptomatic) and the carotid endarterectomy group (170 patients: 67.3±9.4 years, 59.4% symptomatic). The method of carotid revascularization was chosen by multi-disciplinary team consisting of interventionist, vascular surgeon and neurologist with consideration of patients’ clinical and anatomical characteristics that defined the risk of an intervention. The study end points included any stroke, myocardial infarction (MI), death and the composite of them during 30 days after intervention and at a mean 16.4±9.5 months of follow-up. Results: there was no significant difference between the stenting group and the endarterectomy group in the rates of stroke (1.2% and 1.8%, p=1.0), MI (0% and 1.2%, p=0.498), death (0% and 1.2%, p=0.498) and the composite end point (1.2% and 2.9%, p=0.448) within 30 days after inter-vention. At a mean 16.4±9.5 months of follow-up there was also no significant difference in the rates of end points between the stenting group and the endarterectomy group (for composite end point: 5.9% and 6.5%, p=1.0). Conclusions: the carotid stenting and endarterectomy when chosen with consideration of pa-tient- specific risk factors demonstrate low rates of stroke, myocardial infarction, death and the composite end point that are not significantly different between both procedures. The use of carotid stenting and endarterectomy as complementary therapies provides the best patient-oriented care for complex patient population met in daily clinical practice. 937 Interventional neurology Computed tomography perfusion parameter to predict cerebral hyperperfusion phenomenon following carotid artery stenting Y.T. Yoichiro1, T.M. Mori2, T.I. Iwata3, Y.M. Miyazaki4, M.N. Nakazaki5 Shonan Kamakura General Hospital Stroke Center, Kamakura, JAPAN1, Shonan Kamakura General Hospital Stroke Center, Kamakura, JAPAN2, Shonan Kamakura General Hospital Stroke Center, Kamakura, JAPAN3, Shonan Kamakura General Hospital Stroke Center, Kamakura, JA-PAN4, Shonan Kamakura General Hospital Stroke Center, Kamakura, JAPAN5 Purpose: Although SPECT is useful for predicting and finding cerebral hyperperfusion phenomenon (CHP) following carotid artery stenting (CAS), there are few institutions that could perform SPECT during peri-CAS period. The purpose of our study is to evaluate whether or not parameters derived from CT perfusion (CTP) used widely can predict CHP. Methods: Patients who underwent CTP before elective CAS and SPECT before and immediately after elective CAS in our institution from December 2010 to November 2012. We defined CHP as post-CAS increase of more than 10% of the ratio of cerebral blood flow (CBF) in the territory of the affected middle cerebral artery (MCA) divided by CBF in the ipsilateral cerebellum (MCA/CE ratio) measured by SPECT. We assessed the correlation of pre-CAS CTP’s parameters’ ratio to MCA/CE ratio change between pre-CAS and post-CAS SPECT. The CTP’s parameters’ ratio was calculated as (parameters in the affected side divided by in the unaffected side) x 100. CTP parameters we as-sessed are as follows: time-to-peak (TTP), mean-transit-time (MTT), cerebral blood volume (CBV) and CBF. Results: Sixty-five patients were analyzed. Pre-CAS TTP ratio (r = 0.323, p = 0.009) and MTT ratio (r = 0.317, p = 0.010) showed a significant positive correlation with MCA/CE ratio change. Other parameters (CBV and CBF) had no significant correlation. The cut-off value of pre-CAS TTP and MTT ratio was 1.08 (AUC = 0.81, Sensitivity 85.7%, Specificity 70.0%), 1.05 (AUC = 0.74 Sensi-tivity 64.3%, Specificity 44.7%) to predict CHP respectively. Conclusion: Increase of pre-CAS TTP ratio or MTT ratio is probably correlated with CHP following elective CAS.
Karger_ESC London_2013
To see the actual publication please follow the link above