Purpose: ischemic stroke is a major cause of adult disability and the 3rd leading cause of death.Approximately 15-30% of ischemic strokes are caused by obstructive carotid atherosclerosis involving the carotid bifurcation.The purpose of this study is to determine safety, short andmid-term outcomes of cas (carotid artery stenting) during the last 5 years in a single cerebrovascular disease specialized hospital.Methods: between january 2006 and december 2014, 106 successful cas out of 106 attempted procedures in 96 patients were included in this study.The indications for cas were symptomatic carotid-artery stenosis 60% and asymptomatic stenosis of at least 80%.There were 74 men and 22 women and their age range was 50-79 years (mean 71.1).Self expanding stents with cerebral protection devices were used in all cases.Acetylsalicylic acid (100mg/d) and clopidogrel (75mg/d) were applied for at least 4 to 5 days prior to procedure.Weight-adjusted (70u/kg) heparin was used.Atropine (1mg) was given intravenously, if needed, to reduce bradycardia and hypotension potentially associated with carotid dilation.Acetylsalicylic acid (100mg/d) and clopidogrel (75mg/d) was continued for 3 months after the interventional procedure.Mono antiplatelet therapy (aspirin, clopidogrel, or ticlopidine) was continued indefinitely.One hundred six stents (56 protɇɬ 37 precise stent, 12 wallstent, and 2 acculink) and distal filters (94 spider rx, 9 filter-wire, 3 embo-shield) were used.Result: there were one death (huge ich) and 4 minor strokes (3.7%) as peri-procedural complications.Follow-up angiography was done in 78 patients (73.5%) for 6-58 months (mean 17.3), there was only one restenosis (0.9%).Clinical follow-up was done for 94 patients (88.6%) for 6-60 months (mean 32), there were two deaths (1.8%), one major stroke (basilar artery, 21 months), and one minor stroke (cerebellum, 10 months).Conclusion: cas is an effective treatment modality and as safe as cea for carefully selected patients.Judicious selection of the procedure is made on a case-by-case after considering the patient (physiological), lesion, and access (anatomical) factors that increase the risk of cas and cea in that particular patient.
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