{
  "abstract": "Background Resent CREST 2 trials demonstrates long-term benefits in preventing stroke, MI and death when carotid artery stent (CAS) is added to the intensive medical management (IMM), but no benefits observed if carotid artery endarterectomy (CEA) is added to IMM.Objective Objective of this study is to evaluate the long-term incidence of stroke and/or In-stent stenosis/thrombosis among patients received CAS in addition to IMM for asymptomatic and symptomatic carotid artery stenosis.Methods From a prospectively maintained database of 212, 178 consecutive patients who underwent CAS for ≥ 70% stenosis in addition to the IMM from January 2012 to December 2022were included and data was retrospectively analyzed. Patients demographics, periprocedural and long-term (36 -60 months) events including stroke and in-stent stenosis (ISS)/occlusion (ISO) were obtained. Post CAS ollow-up-visit (FUV) were scheduled; 2 weeks 4 weeks, 3, 6, 12 months and yearly if no ISS/stroke. Outcome was measured using modified ranking scale (mRS).Results A total of 178 with a median age of 69 (39-91) female 39.55%, symptomatic 69% asymptomatic 31% underwent CAS in two community based tertiary care facilities. Embolic protection device (EPD) was used in 68% and 42% didn’t receive EPD due to the tortuosity or critical stenosis. The overall perioperative events without death, stroke and MI was observed in 7 cases (3.9%). Cerebral ischemic event (CIE) were observed in 2 symptomatic cases (1.2%) and no CIE was observed in asymptomatic patients. Groin complications was 2.42% (4 patients); anterior small hematoma in 3, closure device related ischemic leg in a 65-year-old who required urgent repair and achieved mRS 0. Asymptomatic patients achieved their baseline mRS in 90 days.In long-term, no patient developed stroke in the CAS territories. The ISS/ISO was observed in 3.9% (7patients; 5 in right and 2 in left, patients were prior and current smoker despite counseling) including 2 with asymptomatic ISO (1.2%) (didn’t attend FUV and stopped antiplatelets). Events in compliant group was 2.8% (5 patients). First patient was a 62 Y/O man underwent right CAS for asymptomatic 80% stenosis 6 months prior to the presentation with ICA stoke and asymptomatic right ISO; received left CAS with IMM and stent remained patient in 48 months. The second patient was a 39 Y/O woman received CAS for symptomatic right ICA 70% who found to have right ISO at 8 months by ultrasonography; remained asymptomatic in 60 months. Asymptomatic ISS identified by ultrasonography in 5 patients between 9-12 months FUV who underwent balloon angioplasty in 2 and drug-eluding balloon mounted stent placement in 3 without any events. All ISS patients received intra-operative intraarterial integrilin 5 mg before and 5 mg after angioplasty/stenting. In 48 months FUV no ISS identified and patient remained asymptomatic.Conclusions We identified a low rate of ISS without stroke in patients who received CAS in addition to IMM. The ISO is associated with non-compliant with FUV and antiplatelets. Both ISS and ISO develop early and associated with Smoking. Therefore, a strict immediate and long-term FUV in addition to pre-CAS counseling is strongly recommended for CAS patientsDisclosures Y. Lodi: None. V. Reddy: None. T. Wang: None. A. Babiker: None. M. Azab: None. D. Rosenbaum: None.",
  "authors": [
    {
      "affiliations": [
        "Neurointerventional Surgery and Stroke, One Brooklyn Health/Downstate Health Science University, Brooklyn, NY"
      ],
      "name": "Y Lodi"
    },
    {
      "affiliations": [
        "UHS-Hospitals and Upstate Medical University, Johnson City, NY"
      ],
      "name": "V Reddy"
    },
    {
      "affiliations": [
        "Neurointerventional Surgery and Stroke, MMC/Downstate Health Science University, Brooklyn, NY"
      ],
      "name": "T Wang"
    },
    {
      "affiliations": [
        "Neurointerventional Surgery and Stroke, One Brooklyn Health/Downstate Health Science University, Brooklyn, NY"
      ],
      "name": "A Babiker"
    },
    {
      "affiliations": [
        "Neurointerventional Surgery and Stroke, One Brooklyn Health/Downstate Health Science University, Brooklyn, NY"
      ],
      "name": "M Azab"
    },
    {
      "affiliations": [
        "Neurointerventional Surgery and Stroke, One Brooklyn Health/Downstate Health Science University, Brooklyn, NY"
      ],
      "name": "D Rosenbaum"
    }
  ],
  "title": "E-155 Long-term in-stent stenosis and/or occlusion including stroke in patients who received carotid artery stent in addition to the intensive medical management; a multi-center cohort",
  "uid": "6ef709f7-2786-5da2-86fe-14974a03446f"
}