Abstract 1122‐000227: Stenting Versus Medical Treatment for Chronic Internal Carotid Artery Occlusions: A Systematic Review and Meta‐analysis
Introduction: Chronic internal carotid occlusion is responsible for 10–15% ischemic strokes or transit ischemic attacks (TIA). Subsequent ipsilateral ischemic stroke rate is 5.9% per year. However, this risk can increase up to 23% in two years in a subgroup of patients with poor collaterals regardle...
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| Format: | Article |
| Language: | English |
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Wiley
2021-11-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.01.suppl_1.000227 |
| _version_ | 1828059441062215680 |
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| author | Cynthia Zevallos Mau Cynthia B Zevallos Milagros Galecio‐Castillo Sameer Ansari Julie Weng Juan Vivanco‐Suarez Andres Dajles Darko Quispe‐Orozco Alan Mendez‐Ruiz Mudassir Farooqui Santiago Ortega‐Gutierrez |
| author_facet | Cynthia Zevallos Mau Cynthia B Zevallos Milagros Galecio‐Castillo Sameer Ansari Julie Weng Juan Vivanco‐Suarez Andres Dajles Darko Quispe‐Orozco Alan Mendez‐Ruiz Mudassir Farooqui Santiago Ortega‐Gutierrez |
| author_sort | Cynthia Zevallos Mau |
| collection | DOAJ |
| description | Introduction: Chronic internal carotid occlusion is responsible for 10–15% ischemic strokes or transit ischemic attacks (TIA). Subsequent ipsilateral ischemic stroke rate is 5.9% per year. However, this risk can increase up to 23% in two years in a subgroup of patients with poor collaterals regardless of medical therapy with antiplatelet or anticoagulant agents. Prevention of subsequent stroke in patients with carotid artery occlusion remains a difficult challenge. Carotid artery stenting (CAS) has recently been considered in its management. However, there is ambiguity on its safety. We aim to evaluate the safety and feasibility of CAS and compared it with medical management. Methods: We performed a systematic review and meta‐analysis to compare long‐term outcome (stroke recurrence) of current carotid occlusion treatments (CAS vs medical therapy). Two independent reviewers performed the screening, data extraction, and quality assessment. A random effects model was used for analysis. Results: A total of 5720 studies were screened. Of these, 11 studies were included in our systematic review and meta‐analysis of proportions. The CAS group has lower proportions of recurrent strokes (5% vs 30%,) after 30 days than medical therapy alone. Additionally, the proportion of periprocedural intracranial hemorrhage was 4.4% (95% CI 2.5 to 6.8) in the CAS group. Conclusions: CAS of the chronically occluded cervical ICA seems to be a safe procedure with lower rates of recurrent stroke in clinical follow up. Future randomized studies are warranted to guide the optimal management of this complex disease. |
| first_indexed | 2024-04-10T21:43:02Z |
| format | Article |
| id | doaj.art-dbf000756bb0483fade4d2848953efa1 |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-04-10T21:43:02Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-dbf000756bb0483fade4d2848953efa12023-01-18T21:39:24ZengWileyStroke: Vascular and Interventional Neurology2694-57462021-11-011S110.1161/SVIN.01.suppl_1.000227Abstract 1122‐000227: Stenting Versus Medical Treatment for Chronic Internal Carotid Artery Occlusions: A Systematic Review and Meta‐analysisCynthia Zevallos Mau0Cynthia B Zevallos1Milagros Galecio‐Castillo2Sameer Ansari3Julie Weng4Juan Vivanco‐Suarez5Andres Dajles6Darko Quispe‐Orozco7Alan Mendez‐Ruiz8Mudassir Farooqui9Santiago Ortega‐Gutierrez10University of Iowa Hospitals and Clinics, Iowa City Iowa United States of AmericaUniversity of Iowa Hospitals and Clinics, Iowa City Iowa United States of AmericaUniversity of Iowa Hospitals and Clinics, Iowa City Iowa United States of AmericaUniversity of Iowa Hospitals and Clinics, Iowa City Iowa United States of AmericaUniversity of Iowa Hospitals and Clinics, Iowa City Iowa United States of AmericaUniversity of Iowa Hospitals and Clinics, Iowa City Iowa United States of AmericaUniversity of Iowa Hospitals and Clinics, Iowa City Iowa United States of AmericaUniversity of Iowa Hospitals and Clinics, Iowa City Iowa United States of AmericaUniversity of Iowa Hospitals and Clinics, Iowa City Iowa United States of AmericaUniversity of Iowa Hospitals and Clinics, Iowa City Iowa United States of AmericaUniversity of Iowa Hospitals and Clinics, Iowa City Iowa United States of AmericaIntroduction: Chronic internal carotid occlusion is responsible for 10–15% ischemic strokes or transit ischemic attacks (TIA). Subsequent ipsilateral ischemic stroke rate is 5.9% per year. However, this risk can increase up to 23% in two years in a subgroup of patients with poor collaterals regardless of medical therapy with antiplatelet or anticoagulant agents. Prevention of subsequent stroke in patients with carotid artery occlusion remains a difficult challenge. Carotid artery stenting (CAS) has recently been considered in its management. However, there is ambiguity on its safety. We aim to evaluate the safety and feasibility of CAS and compared it with medical management. Methods: We performed a systematic review and meta‐analysis to compare long‐term outcome (stroke recurrence) of current carotid occlusion treatments (CAS vs medical therapy). Two independent reviewers performed the screening, data extraction, and quality assessment. A random effects model was used for analysis. Results: A total of 5720 studies were screened. Of these, 11 studies were included in our systematic review and meta‐analysis of proportions. The CAS group has lower proportions of recurrent strokes (5% vs 30%,) after 30 days than medical therapy alone. Additionally, the proportion of periprocedural intracranial hemorrhage was 4.4% (95% CI 2.5 to 6.8) in the CAS group. Conclusions: CAS of the chronically occluded cervical ICA seems to be a safe procedure with lower rates of recurrent stroke in clinical follow up. Future randomized studies are warranted to guide the optimal management of this complex disease.https://www.ahajournals.org/doi/10.1161/SVIN.01.suppl_1.000227Carotid Stenting And AngioplastyCarotidMedical Management |
| spellingShingle | Cynthia Zevallos Mau Cynthia B Zevallos Milagros Galecio‐Castillo Sameer Ansari Julie Weng Juan Vivanco‐Suarez Andres Dajles Darko Quispe‐Orozco Alan Mendez‐Ruiz Mudassir Farooqui Santiago Ortega‐Gutierrez Abstract 1122‐000227: Stenting Versus Medical Treatment for Chronic Internal Carotid Artery Occlusions: A Systematic Review and Meta‐analysis Stroke: Vascular and Interventional Neurology Carotid Stenting And Angioplasty Carotid Medical Management |
| title | Abstract 1122‐000227: Stenting Versus Medical Treatment for Chronic Internal Carotid Artery Occlusions: A Systematic Review and Meta‐analysis |
| title_full | Abstract 1122‐000227: Stenting Versus Medical Treatment for Chronic Internal Carotid Artery Occlusions: A Systematic Review and Meta‐analysis |
| title_fullStr | Abstract 1122‐000227: Stenting Versus Medical Treatment for Chronic Internal Carotid Artery Occlusions: A Systematic Review and Meta‐analysis |
| title_full_unstemmed | Abstract 1122‐000227: Stenting Versus Medical Treatment for Chronic Internal Carotid Artery Occlusions: A Systematic Review and Meta‐analysis |
| title_short | Abstract 1122‐000227: Stenting Versus Medical Treatment for Chronic Internal Carotid Artery Occlusions: A Systematic Review and Meta‐analysis |
| title_sort | abstract 1122 000227 stenting versus medical treatment for chronic internal carotid artery occlusions a systematic review and meta analysis |
| topic | Carotid Stenting And Angioplasty Carotid Medical Management |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.01.suppl_1.000227 |
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