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Significant regression of carotid artery stenosis after treatment with proprotein convertase subtilisin/kexin type 9 serine protease inhibitor

Urology & Nephrology Open Access Journal
Nang San Hti Lar Seng,3,4 Htin Kyaw,3 Nay Min Tun,3 Shwe Synn,3 Thwe Thwe Tun,Alexander Myint Swan,3 Tracy Than Swan,3 Kyaw Hla,3 Htun M Aung,3 Nway Nway,3 May T Zin,3 Alexander Myint Swan1,2,3


Carotid artery stenosis is one of the major causes of ischemic stroke. Optimal medical treatment   includes   controlling   diabetes,   hypertension,   and   hyperlipidemia,   smoking   cessation,  and  anti-platelets  to  slow  down  the  atherosclerotic  plaque  progression  and are important in secondary stroke prevention. Carotid endarterectomy (CEA) or carotid artery stenting (CAS) is the standard of care for patients with symptomatic carotid artery stenosis >70% who has a perioperative stroke or mortality rate <6%. To date, there has been no report on medical revascularization of carotid artery stenosis. Here we report a case of a 94-year-old patient with asymptomatic 85% right internal carotid artery (ICA) stenosis, who benefited a 23% plaque regression after 2 years of evolocumab (Proprotein Convertase Subtilisin/kexin Type 9 Serine Protease Inhibitor) (PCSK-9 inhibitor) injection for her atherosclerotic coronary artery disease. While further studies are necessary, we proposed that PCSK-9 inhibitor could be a safe, promising alternative to CEA or CAS in the revascularization of carotid artery stenosis.


carotid artery stenosis, pcsk-9 inhibitor, evolocumab, carotid endarterectomy, carotid artery stenting