• Brian T Jankowitz, Daniel A Tonetti, Cynthia Kenmuir, Rahul Rao, William J Ares, Benjamin Zussman, Merritt W Brown, Jeremy G Stone, Paul A Gardner, Robert M Friedlander, Bradley A Gross, Ashutosh P Jadhav, and Tudor G Jovin.
• Cooper Neurological Institute, Camden, New Jersey.
• Neurosurgery. 2020 Sep 15; 87 (4): 811-815.

BackgroundPatients with symptomatic carotid stenosis remain at high risk of early recurrent stroke without revascularization. This risk must be balanced against a higher rate of periprocedural complications associated with early revascularization.ObjectiveTo analyze prospectively recorded data from an institutional protocol that standardized the urgent (<48 h) treatment of patients presenting with symptomatic carotid stenosis and underwent either carotid stenting (CAS) or carotid endarterectomy (CEA).MethodsAll patients presenting over 28 mo to a comprehensive stroke center with symptomatic carotid stenosis within 48 h of index event were screened for inclusion. All patients were given dual-antiplatelet therapy. If there was clinical equipoise between CEA and CAS, patients underwent angiography and subsequently revascularization if digital subtraction angiography demonstrated ≥50% stenosis. The primary outcome was a composite of stroke or death within 30 d.ResultsThis study included 178 patients with a diagnosis of recently symptomatic carotid stenosis; 120 patients (67%) met the criteria. A total of 59 patients underwent CEA and 61 patients underwent CAS. There were not significant differences in the primary outcome; 3 patients (5.1%) in the CEA arm and 3 patients (4.9%) in the CAS arm met the primary outcome.ConclusionIn this prospective analysis, urgent revascularization for symptomatic carotid stenosis can be done with equivalently low rates of stroke or death, regardless of revascularization strategy.Copyright © 2020 by the Congress of Neurological Surgeons.

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