Medical Therapy Versus Endovascular Therapy For Severe Extracranial Atherosclerotie Carotid Artery Stenosis

Objective:Compare the efficacy and safety between medical and endovascular treatment for severe extracranial atherosclerotic carotid artery stenosis.Methods:To review a total of86cases of severe extracranial atherosclerotic carotid artery stenosis with ischemic cerebrovascular diseases who were hospitalized in Neurology and Neurosurgery departments of Beijing Hospital from2009to2011, including56ischemic stroke cases,14transient ischemic attack (TIA) cases,16cases with severe extracranial atherosclerotic carotid artery stenosis. These cases are divided into medical treatment group and endovascular treatment group,42cases in medical group and44cases in endovascular group. Through follow-up, to compare the incidence of cerebrovascular events which including transient ischemic attack (TIA), cerebral infarction, cerebral hemorrhage, and the incidence of death events in3months and12months separatly between medical group and endovascular group. At the same time, to compare the incidence of cerebrovascular events in twelve months between the responsible vascular stenting group and the nonresponsible vascular stenting group.Results:In the medical group,6patients had cerebrovascular events in3month, including4ischemic stroke cases and2TIA cases, in which1patient died of the complication of ischemic stroke. And15cases had cerebrovascular events in12months, including10ischemic stroke cases4TIA cases and1cerebral hemorrhage case, in which4patients died of the complication of ischemic stroke.In the endovascular group,1patient had cerebrovascular event of TIA in3months. And6patients had cerebrovascular events in12months, including5ischemic stroke cases and1TIA case, in which1died of the complication of ischemic stroke. And5out of32responsible vascular stenting patients and1out of12nonresponsible vascular stenting patients had cerebrovascular events in12months.26patients with carotid sinus reflex and1patient with ophthalmic artery embolization were found during the operations, and1patient had a local hematoma of the puncture after the operation. After timely and effective treatments, no serious consquences happened. No occurrence of new stroke was found.After3months and12months, the incidence of cerebral events in medical group is statistically significantly higher than the endovascular group (P<0.05). But no statistically difference of the mortality is showed between the two groups (P>0.05) in12months. And there is no statistically difference of the incidence of cerebrovascular events in12months between the responsible vascular stenting group and the nonresponsible vascular stenting group (P>0.05).Conclusion:Compared with the medical group, the endovascular group might display a better short-term prevention of cerebrovascular events with high safety for severe extracranial atherosclerotic carotid artery stenosis. And cases suffering from cerebrovascular events in the responsible vascular stenting group were more than those in the nonresponsible vascular stenting group, but there is no statistically difference between these two groups.