Annals of Indian Academy of Neurology
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ORIGINAL ARTICLE
Year : 2018  |  Volume : 21  |  Issue : 3  |  Page : 179-183

Comparison of best medical management with carotid intervention procedures in the prevention of stroke recurrence in patients with symptomatic internal carotid artery stenosis


1 Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
2 Hitam Cardiac Centre, Warangal, Telangana, India
3 Department of Neurology, Apollo Hospitals, Hyderabad, Telangana, India
4 Department of Radiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
5 Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
6 Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, Telangana, India

Correspondence Address:
Dr. Subhash Kaul
Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, Hyderabad - 500 003, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.AIAN_124_18

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Background: As per the current recommendations, carotid interventional procedures (carotid endarterectomy/carotid artery stenting) are considered superior to medical management in reducing the stroke recurrence in patients with symptomatic extracranial internal carotid artery (ICA) stenosis. Objective: The objective of this study is to compare the best medical management with carotid interventional procedures in the prevention of stroke recurrence in the patients with symptomatic extracranial ICA stenosis. Materials and Methods: This was a parallel, prospective, two-arm, open-label, observational study. Participants were selected consecutively and prospectively among patients from Outpatient and Inpatient Departments of Neurology at Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India. The study period was from January 2012 to December 2017. Results: Of 150 patients with symptomatic extracranial ICA stenosis of ≥50%, 100 preferred best medical management (m = 75, f = 25) and 50 (m = 37, f = 13) opted for carotid intervention. The mean age of the patient cohort was 59.8 ± 12.7. Follow-up was done at regular intervals from 3 months to 1 year. In the medical group, the recurrence occurred in 10 patients; 4 (40%) within 6 months, 5 (50%) within 6–12 months, and 1 (10%) after 1 year. In the intervention group, the recurrence occurred in 6 patients; 5 (83%) within the first 6 months and 1 (17%) within 6–12 months. Conclusions: Overall, there was no statistically significant difference in the rate of recurrence between the best medical management and the carotid interventional procedures.


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