Outcome of Ischemic Stroke Patients After Carotid Stenting without a Protection Device

Abstract

Background: Carotid angioplasty and stenting are treatment options for ischemic stroke patients who have carotid stenosis. Previous studies showed mixed results about its efficacy and functional outcome.

Objective: The purpose of the study was to observe the functional outcome of ischemic stroke patients after carotid stenting without a protection device.

Methodology: This prospective hospital-based longitudinal study was conducted at BSMMU during October 2022 to September 2023 on patients with >50% extracranial ICA stenosis, measured by NASCET. Imaging (Doppler/MRA/DSA) confirmed stenosis. Stenting was performed, followed by MRI (DWI) within 48 hours. Functional outcome was assessed using mRS before and 1 month after stenting.

Result: A Total of 39 patients were analyzed in the study. The mean age of the respondents was 59.8 ± 9.4 years. About 79.5% participants were male and 20.5% were female. Hypertension was found most common among the patients (76.9%) followed by DM (51.3%), Smoking (38.5%), dyslipidemia (38.5%), and CKD (12.8%). Before stenting, 97.4% patients had DWI lesions on MRI. Severe carotid stenosis was found among 89.7% patients and 69.2% lesions were ulcerated. Calcification was present in 17.9% lesions and 33.3 % lesions were more than 15 mm in length. Carotid stenting without any distal protection device was done on the left side in 64.1% of the patients and 35.9 % had right-sided carotid stenting. Within 48 hours after stenting, MRI of the Brain showed a new DWI lesion in 7.7 % patients. Before stenting, only 9 (23.1%) patients had mRS 0-2, whereas one month after stenting, 38(97.4%) patients achieved a good functional outcome, which was statistically significant (p value< 0.001).

Conclusion: Carotid stenting without protection devices is a safe and effective treatment, yielding significantly improved functional outcomes.