Aggressive medical treatment versus carotid artery stenting in management of carotid artery stenosis: An Egyptian study

Background: Carotid revascularization is superior to medical treatment in stroke prevention in patients with severe symptomatic or asymptomatic atherosclerotic carotid artery stenosis. However, integrated aggressive medical treatment should be tested against revascularization. Objective: To compare CAS under protection device with aggressive medical treatment. Methods: Seventy-five patients with significant carotid stenosis were divided into three groups; double antiplatelets (DAP) group (acetyl-salicylic acid 150 mg/day + clopidogrel 75 mg/day), oral anticoagulation (OAC) group (INR level between 2-2.5 plus acetyl-salicylic acid 150 mg/day) and carotid artery stenting (CAS) group. All patients were followed for at least 6 months. End point was ipsilateral transient ischemic attack (TIA), ipsilateral ischemic stroke, intracranial hemorrhage and vascular death. Results: The study was done on two stages. The 2 nd stage decision was based on results of 1 st stage (patients who had new ischemic event on certain modality were shifted to another one). In the 1 st stage, 57 patients were treated conservatively (39 on DAP and 13 on OAC) and 17 patients underwent CAS. CAS group was associated with significantly (p=0.01) better outcome. Twenty-six (45%) patients of medical group had new ipsilateral cerebral vascular event, while 2 (12%) patients of CAS group developed new ipsilateral vascular event (periprocedural TIAs). The 2 nd decision included 29 patients; 22 patients underwent CAS, 5 patients were shifted to OAC and 2 patients to DAP. Among patients in CAS group, one (4.5%) developed ischemic stroke while among the 7 patients on medical management, one patient (14.2%) developed new ischemic stroke. Conclusion: CAS under protection device is associated with better outcome than aggressive medical treatment.