CONCLUSION
Completing the study of 19 patients with the
carotid artery stenting, we have drawn out the
following conclusions:
- Clinical characteristics: age was quite
high (>60 years old), patients had many high
risk factors of stroke such as hypertension,
dyslipidemia, smoking, and diabetes, in which
hypertension is the most common. The majority
of patients had a history of stroke.
- The patients whose stenosis was ≥ 70% and ≥
90% accounted for 100% and 47.4% respectively,
accompanied by vascular lesions at high risk of
stroke such as calcified lesion and ulcerated lesion.
- The success of the procedure was 100%,
the degree of stenosis after intervention was
significantly improved. There was no severe events
such as embolism, cerebral infarction or cerebral
hemorrhage during and after the intervention.
Some common symptoms were sinus bradycardia,
headache, nausea, vomiting.
- After 6 months, clinical outcomes and the
prognosis improved according to NIHSS and
mRS. There was neither death case nor cerebral
hemorrhage and recurrent cerebral infarction.
Re-stenosis was very low, only one case of
re-stenosis (who is related to Takayasu’s
pathology) required intervention.
- The carotid artery stenting was an alternatively
safe method, which is also a good prognosis.
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Hue Central Hospital
Journal of Clinical Medicine - No. 62/2020 9
ASSESSING SHORT-TERM OUTCOMES OF
CAROTID ARTERY STENTING AT HUE CENTRAL HOSPITAL
Hoang Hai Phu1, Le Vu Huynh2, Pham Dinh Chuong1
DOI: 10.38103/jcmhch.2020.62.2
ABSTRACT
Stroke is an important medical problem in all countries of the world. Preventing stroke is a priority
goal of community health programs and each individual. Carotid stenting is a less invasive alternative
in comparison to surgery. This study was conducted on 19 patients with internal carotid artery stenosis,
in which the stent was placed to recreate the flow, at Hue Central Hospital from January 2018
to January 2020. Results: Age was 61.1 ± 16.1 years, history stroke was 57.9%, hypertension was
78.8%, dyslipidemia was 68.4%, smoking was 57.9%, bilateral carotid lesion was 57.9%, the patients
whose stenosis was ≥70% and ≥ 90% accounted for 100% and 47.4% respectively, the success of the
procedure was 100%, blood flow to the brain improved (36.7%). There was no case with dangerous
events such as embolism, infarction or cerebral hemorrhage. After 6 months, clinical outcomes and
the prognosis improved according to NIHSS and mRS. No death or complication of cerebral infarction,
cerebral hemorrhage was reported.
Key words: carotid artery, stent, cerebral infarction, cerebral hemorrhage
1. Internal Medicine Department of International Centre,
Hue Central Hospital;
2. Stroke department, Hue Central Hospital
Corresponding author: Hoang Hai Phu
Email: drhoanghaiphu25@gmail.com
Received: 8/5/2020; Revised: 17/5/2020
Accepted: 20/6/2020
I. INTRODUCTION
Stroke is an important medical problem in all
countries of the world due to its high incidence,
mortality and disability. In western countries,
stroke is the fourth leading cause of death, after
heart disease, cancer and chronic respiratory
disease [1]. Of these, carotid artery disease
accounts for 10 to 15% of all ischemic causes of
stroke [2]. In the United States, stroke was ranked
as the third leading cause of death, after ischemic
heart disease and cancer. Every year, about
160.000 out of 800.000 patients die of stroke. In
2009, the economic burden was estimated at $
68.9 billion in direct and indirect costs. This is also
the most important cause of disability, with 20%
of survivors needing care in the health facilities
after 3 months and 30% permanently disabled. The
burden is expected to worsen in the next 20 years,
in part due to the aging population, especially in
developing countries [1, 3, 4].
Preventing stroke is the priority goal of
community health programs and each individual.
Extracranial cerebrovascular stenosis reduces the
pressure of distal perfusion, increases the speed
of blood flow, causing ulceration, desquamation
of atheroma causing stroke [5]. Randomized
controlled trials (RCTs) have shown the benefits of
carotid endarterectomy to treat patients with carotid
artery disease and are an effective method to prevent
stroke. Over the past two decades, with advances in
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10 Journal of Clinical Medicine - No. 62/2020
Assessing short-term outcomes of carotid artery ste ting...
science, technology, equipment, and experience of
the surgeon, carotid stenting has emerged as a less
invasive alternative compared to surgery to treat
patients with internal carotid artery disease.
Extracranial cerebrovascular stenosis was
identified by the American Heart Association
(AHA) in 2011 as one of the risks of stroke and
stenting is recommended when stenosis is over 50%
symptomatic (group IB), over 70% asymptomatic
(group IIB) [6]. Stenting for extracranial
cerebrovascular stenosis is a safe and effective
treatment that has been proven in many countries
around the world. In Vietnam, in recent years, along
with the strong development of the Interventional
radiology industry, stenting for extracranial
cerebrovascular stenosis has frequently indicated.
Therefore, the current research aims to:
- Assessing the success rate and the events of
stenting for carotid artery stenosis at Hue Central
Hospital.
- Assessing short-term effectiveness of patients
after the intervention.
II. MATERIALS AND METHODS
2.1. Participants
19 patients with internal carotid artery stenosis
was placed stent to recreate the flow at Hue Central
Hospital from January 2018 to January 2020.
2.1.1. Criteria for selection
The patients underwent a digital subtraction
angiography (DSA) and met either of the following
two criteria:
- Symptomatic patients whose diameter of the
lumen of the ipsilateral internal carotid artery is
reduced more than 50%.
- Asymptomatic patients whose diameter of the
lumen of the internal carotid artery is reduced more
than 70%.
If the patients have a transient ischemic attack,
amaurosis fugax, or minor nondisabling stroke, they
will be considered to be symptomatic. The degree
of stenosis was determined according to the North
American Symptomatic Carotid Endarterectomy
Trial (NASCET) criteria.
2.1.2. Exclusion criteria
Patients who are older than 80 years, stroke less
than 4 weeks, severe renal failure, uncontrolled heart
arrhythmia, contraindications to antiplatelet agents,
coagulopathy and patients refusing to perform the
procedure were excluded from the study.
2.2. Research methods
- Descriptive, prospective and follow-up for 6
months after interventions.
- Ultrasound performed on Phillip HD 11, taking
DSA and interfering with stenting on Phillip Intergis 9.
- Data analysis by SPSS 23.0 software.
III. RESULTS AND DISCUSSION
Having conducted the research on 19 patients
with the carotid artery stenting, we obtained the
following results:
3.1. Participants’ characteristics
Table 1: Participant’s clinical characteristics
Characteristics Result (N=19)
Age, (mean ± SD) 61.1 ± 16.1
BMI, (mean ± SD) 22.1 ± 1.5
History of cerebral infarction
and / or TIA, n (%)
11 (57.9%)
Diabetes, n (%) 6 (31.6%)
Hypertension, n (%) 15 (78.9%)
Dyslipidemia, n (%) 13 (68.4%)
Smoke, n (%) 11 (57.9%)
- The participants were relatively old, along with
many risk factors for vascular disease such as history
of stroke, hypertension, dyslipidemia, smoke, diabetes.
Especially, hypertension, dyslipidemia, and smoking
were the among the most common risk factors.
- Research by Hakan Posacioglu et al (2009):
56 patients were placed stent with an average age
of 65.8 ± 9, of which 35.7% of patients were older
than 70, 69.4% had coronary artery disease, 59.2%
had a stroke and/or transient ischemic attack before
intervention, hypertension was 89.8%, smoking
was 69.4%, lipid metabolism was 32.7%, diabetes
was 20.4% [7].
Table 2: Vascular lesion characteristics
Hue Central Hospital
Journal of Clinical Medicine - No. 62/2020 11
Characteristics Result (N=19)
Lesion distribution, n (%) Lateral stenosis: 8 (42.1%)Bilateral stenosis: 11 (57.9%)
Degree of stenosis, mean ± SD (%)
87.0 ± 6.9 %
Stenosis ≥70%: 19(100%)
Stenosis ≥90%: 9(47.4%)
Lesion length, mean ± SD (mm) 11.2 ± 4.0 mm
Calcified lesion, n (%) 8 (42.1%)
Ulcerated lesion, n (%) 7 (36.8%)
- According to the characteristics of lesion distribution, 57.9% of the participants were mostly
bilateral carotid artery lesions. According to Thomas G. Brost (2010), 50.6% of lesions are the left
carotid artery [5].
- The degree of stenosis is quite severe, the rate of ≥70% is 100%, ≥90% is 47,4%, accompanied by
vascular lesions at high risk of stroke such as Calcified lesion, Ulcerated lesion. According to Thomas G.
Brott (2010), the rate of severe stenosis ≥ 70% is 86.9%, average lesion length: 17.8 ± 8.5mm. According
to Hakan Posacioglu et al (2008) the degree of stenosis ≥ 90% is 19.6% [5, 7].
3.2. Treatment results:
Table 3: Effective procedure for stenting
Characteristics Result (N=19)
Successful ratio, n(%) 19 (100%)
Degree of stenosis before stenting, mean ± SD (%) 87.0 ± 6.9%
Degree of stenosis after stenting, mean ± SD (%) 40.0 ± 14.7%
Stenosis difference before and after the intervention, mean ± SD (%) 72.2 ± 12.3%
Increased blood flow after intervention, n (%) 7 (36.7%)
The success of the procedure was 100%, stenosis difference before and after the intervention was clear
(72.2 ± 12.3%). Blood flow to the brain was improved (36.7%).
Table 4: Carotid artery stenting procedural risk assessment
Events Ratio (N=19)
Sinus bradycadia, n (%) 5 (26.3%)
Embolism during or after intervention, n (%) 0 (0%)
Hemorrhage or Ischemia after intervention n (%) 0 (0%)
Symptoms of reperfusion (headache, nausea, vomiting ...) 4 (21.1%)
- There was no dangerous event related to procedures such as embolism, infarction or cerebral
haemorrhage. Other common events included sinus bradycardia during the procedure, and headache,
nausea, and vomiting due to reperfusion.
- According to the study of Alex Abou-Chebl (2004) retrospecting 450 patients with carotid artery
stenting, the rate of reperfusion syndrome was 5 patients (1.1%), of which 3 patients had hemorrhage
(0.67%), 2 patients died due to increased perfusion (0.44%) [8].
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12 Journal of Clinical Medicine - No. 62/2020
3.3. Short - term effect
Table 5: Features of complications after 6 months
Features Result
(N=19)
Hemorrhage or Ischemia, n(%) 0 (0%)
Re-stenosis after 6 months, n(%) 1 (5.3%)
Mortality, n(%) 0 (0%)
- No dead case or hemorrhage, recurrent infarc-
tion was monitored after 6 months of intervention. 1
patient was re-stenosis related to acquired vascular
pathology (Takayasu).
- CREST Study (2010) was conducted on 1261
intervention patients, in which the mortality was
0.71%, stroke was 4.12%. The ICSS (2010) studied
853 patients, in which the mortality was 2.22% and
stroke was 7.62% [9, 10].
Figure 1: Clinical change after 6 months
After 6 months, clinical outcomes and the prognosis improved according to NIHSS and mRS.
IV. CONCLUSION
Completing the study of 19 patients with the
carotid artery stenting, we have drawn out the
following conclusions:
- Clinical characteristics: age was quite
high (>60 years old), patients had many high
risk factors of stroke such as hypertension,
dyslipidemia, smoking, and diabetes, in which
hypertension is the most common. The majority
of patients had a history of stroke.
- The patients whose stenosis was ≥ 70% and ≥
90% accounted for 100% and 47.4% respectively,
accompanied by vascular lesions at high risk of
stroke such as calcified lesion and ulcerated lesion.
- The success of the procedure was 100%,
the degree of stenosis after intervention was
significantly improved. There was no severe events
such as embolism, cerebral infarction or cerebral
hemorrhage during and after the intervention.
Some common symptoms were sinus bradycardia,
headache, nausea, vomiting.
- After 6 months, clinical outcomes and the
prognosis improved according to NIHSS and
mRS. There was neither death case nor cerebral
hemorrhage and recurrent cerebral infarction.
Re-stenosis was very low, only one case of
re-stenosis (who is related to Takayasu’s
pathology) required intervention.
- The carotid artery stenting was an alternatively
safe method, which is also a good prognosis.
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stroke statistics - 2015 update: a report from
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2. Cremonesi, A., et al., Carotid artery stenting: an
update. 2015. 36 (1): p. 13 - 21.
3. Litsky, J., et al., Management of symptomatic
carotid disease in 2014. 2014. 16 (3): p. 462.
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Journal of Clinical Medicine - No. 62/2020 13
4. Jonas, D.E., et al., Screening for asymptomatic
carotid artery stenosis: a systematic review and
meta-analysis for the US Preventive Services
Task Force. 2014. 161 (5): p. 336 - 346.
5. Brott, T.G., et al., Stenting versus endarterectomy
for treatment of carotid-artery stenosis. 2010.
363 (1): p. 11 - 23.
6. Brott, T.G., et al., Guideline on the management
of patients with extracranial carotid and vertebral
artery disease. 2011. 57 (8): p. 516 - 94.
7. Posacioglu, H., et al., Carotid endarterectomy
versus carotid artery stenting: findings in
regard to neuroclinical outcomes and diffusion-
weighted imaging. 2008. 35 (4): p. 395.
8. Abou-Chebl, A., et al., Intracranial hemorrhage
and hyperperfusion syndrome following carotid
artery stenting: risk factors, prevention, and
treatment. 2004. 43 (9): p. 1596 - 1601.
9. Lancet, I.C.S.S.i.J.T., Carotid artery stenting
compared with endarterectomy in patients with
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Carotid Stenting Study): an interim analysis of
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10. Hill, M.D., et al., Stroke after carotid stenting and
endarterectomy in the Carotid Revascularization
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