Early Results of Carotid Artery Stenting

Background and Objectives Carotid artery stenting has evolved as a potential alternative to carotid endarterectomy in patients pts with significant carotid artery stenosis. We evaluated the feasibility and long-term outcome of carotid artery stenting in selected pts at high surgical risk. Materials and Methods Between May, 1996 and September 1998 we performed carotid artery stenting at 35 lesions in 25 pts. There were 23 males and 2 females. Mean age was 63.2 6.6 range 54 77 . Eight four percent 21/25 of the pts had significant coronary artery disease. Sixty four percent 16/25 of the pts had significant peripheral artery lesions. Sixty percent 15/25 of the pts had neurologic symptoms or non-disabling stroke. We used Wallstent in 32 lesions and Palmaz stent in 3 lesions. Carotid stenting was undertaken in 33 internal carotid, 1 common carotid and 1 external carotid lesions. Bilateral carotid stenting was undertaken in forty percent 10/25 of the pts. Results Carotid stenting was successful in all lesions. One patient died due to massive cerebral hemorrhage 3 days after carotid stenting, who had und-erwent stenting as a rescue procedure for failed endarterectomy. One major stroke developed during procedure with partial recovery. For the combined endpoint of strokes and death within 30 days of procedure, the incidence was 8 and 5.7 in terms of pts and procedures, respectively. On follow-up 12 7 months , we found neither neurologic complications nor death. Angiographic and/or duplex sonography which were performed at 5.5 month in all 18 eligible pts with 24 lesions revealed no evidence of stent deformity or restenosis 50 of diameter stenosis . Mean angiographic stenosis was 20 on follow-up angiography. Conclusion Carotid artery stenting can be performed with high success and low complication rate in pts with significant carotid artery stenosis especially at high surgical risk. Follow-up clinical outcome of average 12 month was good with low restenosis rate.

Follow-up Results of Stent Placement for Extracranial Carotid Artery Stenosis

Yoon¹,

Hong²,

Choi³

et al. 1998

A Case of Transseptal Approach to Carotid Artery Stenting in Right Internal Carotid Stenosis

Kang¹,

Yun

Choi

et al. 1998

Although the carotid endarterectomy presently represents the standard therapeutic approach for most patients with significant carotid artery stenosis, a percutaneous transluminal angioplasty PTA with stenting has become an alternative method for treating patients with comobid conditions, particulary coronary artery disease. A PTA with stenting has the potential for being safer, less traumatic, more cost-effective, and useful in patients at high surgical risk. As well, they are not limited to the cervical carotid artery. But it is reported that carotid angioplasty by femoral approach is difficult to do in 1 2% of patients with carotid stenosis due to abnormal origin of carotid artery or occlusion of femoral arteries. We succeeded in PTA with stenting of tight stenosis of right internal carotid artery through the transseptal approach in case of a sharply angled right brachiocephalic artery take-off from the aorta. The transseptal approach can be used for PTA with stenting in case of problems with femoral approach. Korean Circulation J 1998 ; 28 8 : 1409-1413 KEY WORDS Carotid artery stenosis·Transseptal approach·Percutaneous transluminal angioplasty with stenting.

Stenting of Extracranial Carotid Artery Stenosis

Kong¹,

Chung²,

Kim³

et al. 2000

Background Surgical endarterectomy had been known to be the standard treatment modality in management of carotid stenosis. However, endarterectomy had several limitations in high-risk patients, particulary with coronary artery disease. Carotid angioplasty and stenting has been suggested to be a safer and more cost-effective alternative to carotid endarterectomy in the management of symptomatic carotid artery disease. The purpose of this study is to evaluate the feasibility and safety of elective carotid artery stent implantation in patients with carotid artery stenosis. Method We treated 19 patients with symptomatic and asymptomatic stenosis of 60% in 19 carotid arteries with balloon angioplasty followed by elective stent implantation. Of all carotid stenting procedures, 18 stents were implanted in obstructing atherosclerotic plaques and in one for Takayasu's arteritis. Of all patients, 10 patients were symptomatic with a history of stroke or transient ischemic attacks which were ipsilateral to the treated carotid artery. 12 patients represented a high-risk subset with myocardial infarction, previous coronary artery bypass graft and coronary artery stenosis. 6 months follow up angiogram was done in 7 patients, a patient Takayasu's arteritis showed restenosis. Result Angiographic and procedural success rate were 100%, and there were no acute or subacute stent thrombosis. Immediately after initial carotid stenting, the mean SD stenosis was reduced from 74.9 13.6% to 10.2 8.7% and the minimal luminal diameter was increased from 1.4 0.8 mm to 5.3 1.0 mm corresponding to an acute gain of 3.9 mm. There were no major or minor stokes during follow-up. Conclusion Percutaneous carotid angioplasty with stenting is a safe and feasible procedure. It is associated with high immediate success rates and relatively low complications in the management of carotid artery stenosis. Carotid stenting seems to be a reasonable alternatives to medical management for the treatment of carotid stenosis in patients deemed to be poor candidates for standard carotid endarterectomy.