| Objective:To assess the efficacy and safety of carotid artery stenting and medical therapy in patients with symptomatic extracranial carotid stenosis ,we comparisoned and analysised clinical outcome and imagining follow-up of the two methods in 265 patients, evaluated the value of stent implantation in patients with symptomatic extracranial carotid stenosis.Methods: A retrospective analysis was conducted of a total of 265 patients with symptomatic extracranial carotid stenosis who had full follow-up data in our hospital from 2001 to 2003.All patients were examined by angiography or magnetic resonance angiography.160 patients were treated by means of endovascular stent under local anesthesia.Aspirin (300mg,qd)and ticlopidine (250mg,bid) was given orally and started started 3d before the treatment procedure for the patients.After angioplasty the patients were received aspirin (300mg daily for 6 months,then 100mg daily maintain survival)and ticlopidine(250mg twice a day for 1 month).And 105 patients were received aspirin (300mg daily for 6 months,then 100mg daily maintain survival)and ticlopidine(250mg twice a day for 1 month).All patients were examined by NIHSS 1and 12 months after entry.All ischemic neurological events were recorded and the hemodynamics of carotid artery were detected using ultrasonography during the follow-up period.Clinical and angiographical follow-up was attainable in 265 patients(11-15 months,mean 13.5months).Results:There was a technical success of 100% with 160 carotid arteries treated.The average stenosis rate was reduced from(79.5±14.6)% before treatment to (11.2±7.8)% after stent-assisted angioplasty.The diameter of carotid artery was increased from (1.5±0.6)mm to( 4.1±0.4)mm (P<0.01).The 30-day stroke and death more frequently in medical group,but the difference was not significant (0.63% versus1.9%; P>0.05).The number of major stroke was same in two groups(n=1), the difference was not statistically significant (0.63% versus0.95%; P>0.05).There was 1 death in medical group,no deaths occurred in stent group.During the follow-up(mean 13.5 months) period the ipsilateral stroke rate was 0.63%(n=1),and the total stroke and death was 1.25%(n=2) in stent group. The ipsilateral stroke rate was 2.86%(n=3),and the total stroke and death was 4.76%(n=5) in medical group during the follow-up period.This represented a relative-risk of ipsilateral stroke reduction of 79 percent in stent group than in medical group(P<0.05),the relative-risk of total stroke and death reduction of 75 percent(P<0.05).There was only one asymptomatic restenosis(0.63%),did not receive second intervention. Carotid ultrasonography showed the percent from(79.5±14.6)% to (11.2±7.8)%(P(0.01),PSV was decreased from (352.2±185.5) cm/s to (86.3±26.2)cm/s(P(0.01)in stent group.The diameter of carotid artery was (3.54±0.58)mm in stent group,and (2.50±0.68)mm in medical group during mean 13.5 months follow-up(P(0.05).The PSV was (66.7±18.2 )cm/s in stent group and (205.2±54.6)cm/s in medical group(P(0.01).The proportion of soft plaque(0,45.7%,P(0.01) and ulcerous plaque(0.63%,60%,P(0.01) were significantly lower in stent group.There was one >50% restenosis in stent group with PSV was 250cm/s,was determined by angiography. Before stenting ,turbulent flow patterns were noted in 154 stenotic ICAs.After stenting, turbulent flow patterns returned to laminar flow in these stenotic ICAs.This phenomenon did not happen in medical group.Conclusion: Carotid angioplasty and stenting is more feasible and safe for the treatment of symptomatic extracranial carotid stenosis than medical therapy,the total perioperative stroke and mortality rate is low. At long-term follow-up,the recurrent stroke and restenosis rate is low. Dual antiplatelet therapy is superiority to monotherapy. CAS is play an important role in carotid stenosis due to enlarge vascular capacity, stabiliz plaque and alter flow pattern.Carotid ultrasonography is a reliable method for assessing accurately and following up the effect of carotid artery stent.
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