OBJECTIVE Urgent carotid endarterectomy and carotid artery stenting (CAS) for symptomatic advanced carotid artery stenosis is controversial because carry risks of hemorrhagic and thromboembolic complications. As treatments for preventing recurrent stroke have recently advanced, this study evaluated whether elective CAS with urgent best medical therapy reduces recurrent stroke for symptomatic severe carotid artery stenosis. PATIENTS AND METHODS A total of 131 consecutive patients who underwent CAS for severe stenosis of the carotid artery between 2013-2017 were divided into acute ischemic minor stroke (AIMS) and Asymptomatic groups. The AIMS group comprised 59 patients presenting with minor stroke who underwent elective CAS with oral dual antiplatelet therapy, statin therapy, and add-on oral omega-3 fatty acid ethyl esters from 4 weeks before CAS. The Asymptomatic group comprised 72 patients treated with best medical therapy for 4 weeks before CAS. RESULTS No recurrent ischemic stroke was observed under urgent best medical treatment before elective CAS in the AIMS group. Although the frequency of vulnerable plaque and degree of stenosis were much higher in the AIMS group, no significant differences were seen in perioperative complications. Baseline serum eicosapentaenoic acid (EPA) levels and EPA/ arachidonic acid (AA) were significantly lower in the AIMS group (p = 0.04, 0.04, respectively) and serum EPA/AA was significantly increased a day before CAS and 3 months after CAS compared with baseline. CONCLUSION Urgent best medical treatment reduces recurrent stroke and facilitates safe elective CAS in patients with symptomatic and severe carotid artery stenosis.

中文翻译：

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紧急最佳药物治疗后选择性颈动脉支架置入术可抑制症状性颈动脉严重狭窄患者的卒中复发

目的 紧急颈动脉内膜切除术和颈动脉支架置入术 (CAS) 治疗有症状的晚期颈动脉狭窄是有争议的，因为存在出血和血栓栓塞并发症的风险。随着预防卒中复发的治疗方法最近取得进展，本研究评估了选择性 CAS 和紧急最佳药物治疗是否可以减少症状性严重颈动脉狭窄的复发性卒中。患者与方法 2013-2017 年共 131 例因颈动脉严重狭窄而接受 CAS 的连续患者分为急性缺血性轻微卒中 (AIMS) 和无症状组。AIMS 组包括 59 名出现轻微卒中的患者，他们在 CAS 前 4 周接受了选择性 CAS，包括口服双重抗血小板治疗、他汀类药物治疗和附加口服 omega-3 脂肪酸乙酯。无症状组包括 72 名在 CAS 前接受 4 周最佳药物治疗的患者。结果 AIMS 组在择期 CAS 前紧急最佳药物治疗下未观察到复发性缺血性卒中。尽管 AIMS 组易损斑块的频率和狭窄程度要高得多，但围手术期并发症没有显着差异。相比之下，AIMS 组的基线血清二十碳五烯酸 (EPA) 水平和 EPA/花生四烯酸 (AA) 显着降低（分别为 p = 0.04、0.04），并且血清 EPA/AA 在 CAS 前一天和 CAS 后 3 个月显着增加与基线。结论 紧急最佳药物治疗可减少有症状和严重颈动脉狭窄患者的卒中复发并促进安全的选择性 CAS。