Nih Stroke Scale Changes Following Carotid Artery Stenting

Background: Traditionally, carotid endarterectomy (CEA) has been the primary method of treating high-grade asymptomatic and symptomatic carotid artery stenosis. A carotid endarterectomy involves exposure of the carotid artery and removal of plaque, most typically from the carotid bulb and the proximal internal carotid artery, via a neck incision. However, in vascular surgery, as in many other surgical specialties, minimally invasive techniques have evolved over the years. These techniques offer the advantages of smaller incisions, reduced postoperative pain, reduced potential for postoperative wound complications, and a shorter length of stay in the hospital. Objective: To assess the outcome of carotid stenting for carotid stenosis by assessing the changes in NIH stroke scale before and after carotid artery stenting. Patients and Methods: This clinical trial study was conducted on 15 patients who underwent 15 carotid artery stenting (CAS). The study was carried at Al-Azhar University Hospitals and Mabart Masr Elkadema hospital in the period between July 2019 and July 2020. All patients with carotid stenosis with high-grade asymptomatic (more than 70%) or symptomatic carotid artery stenosis treated with carotid artery stenting were included in this study, All patients with carotid stenosis treated with carotid artery end arterectomy, patients with unfavorable aortic arch anatomy including heavily calcified aortic arch or a type 3 aortic arch, and Patients with a common carotid artery length of less than 5 cm from the clavicle were excluded from our study. Cases were subjected to National Institute of Health Stroke Scale (NIHSS) before and after carotid artery stenting. Results: Most of the current study participants were males (66.7%) with a mean age of 58.9±8.9 years, 80% were symptomatic and 20% were asymptomatic. Most of patients in our study had hypertension (HTN) (80%), (53.3%) had diabetes mellitus (DM) and ischemic heart disease (IHD) and (46.7%) were smokers as males were higher than females. Also, 73.3% had dyslipidemia, 20% of patients were asymptomatic and 80% were symptomatic. Motor weakness was common especially on the left side (47.7%) of patients and right side (20%). Also, dysarthria was presented among 20% of patients, while transient ischemic attack (TIA) was presented among 13.3% of patients. Syncopal attack and deterioration of consciousness were among 6.7% of patients. In our study the degree of stenosis by diagnostic Cathter angiography (DCA) ranged from 60% to 90% with a mean of 72.67%±9.2. Right side was more affected (60%) than left side (40%). As regard National Institute of Health Stroke Scale (NIHSS) constructs, our patients had statistically significant improvement in level of consciousness, level of consciousness (loc) questions, loc commands, sensation and extinction/inattention occurred after 3 months. Also, our patients showed statistical significant improvement in best gaze, motor drift, best language and dysarthria after 3 months. Motor power of left arm and left leg showed statistically insignificant mild deterioration immediately after stenting. Visual field, facial palsy and limb ataxia constructs showed insignificant differences among our study patients as no improvement occurred. Conclusion: CAS showed a high technical success rate and a good short term clinical outcome. CAS is a safe and efficacious procedure especially with the availability of proper materials and experienced staff.