Abstract
Purpose: To determine risk and management after carotid endarterectomy (CEA) or carotid artery stenting (CAS) to treat acute or subacute (AS) carotid stenosis. Methods: We treated 238 consecutive patients by CEA (n=104) or CAS (n=134) and then assigned them to groups treated at the AS (n=17; CEA, n=9; CAS, n=8) or chronic (C) (n=221; CEA, n=95; CAS, n=126) stages. We then evaluated the surgical results of all of these groups. Results: The occurrence rates of transient or permanent ischemic symptoms did not significantly differ between in the AS (permanent, n=1 [6%]) and C (transient, n=3 [1%]; permanent, n=4 [2%]) groups. The occurrence rates of DWI lesions after surgery also did not significantly differ between these groups (AS, n=3 of 14 [21%]; C, 46 of 191 [24%]). More patients had infarction after CAS than CEA in the C group (p<0.01). Hyper-perfusion syndrome was evident in 5 (29%) of the AS group and in 2 (1%) of the C group. Symptoms were permanent in 1 (6%) of the AS group (7%), although none of the patients died. The two groups significantly differed (p<0.01). Prediction and blood pressure (BP) control determined by cerebral blood flow measurements could prevent fatal intracranial bleeding. Conclusion: Hyper-perfusion syndrome frequently occurred in patients treated at the AS stage and the control of BP was necessary for prevention of fatal complication.
