Intraluminal Palmaz Stent Implantation for Treatment of Recurrent Carotid Artery Occlusive Disease: A Plan for the Future

Abstract

While carotid endarterectomy (CEA) has been used commonly and with great effectiveness for de novo carotid occlusive lesions, its success in cases of recurrent disease has been attenuated by a higher incidence of complications and lower durability. Although interventional techniques have been introduced cautiously into the cerebrovascular system, balloon dilation for both primary and recurrent carotid atherosclerotic disease has been successful in establishing an adequate lumen without an increase in embolic complications over surgery. Because the likelihood exists that postdilation restenosis may be as common in the carotid arteries as it is in other vascular segments, the use of intraluminal stenting may mitigate this long-term complication, a benefit that has been demonstrated in other high flow vessels such as the aorta and iliac arteries. To begin an investigation of this hypothesis, we treated a 69-year-old symptomatic man who required a third intervention for recurrent carotid disease. A > 90% stenosis of the distal third of his right common carotid artery was successfully dilated, and a Palmaz stent was deployed without incident. The patient experienced no complications to the percutaneous procedure, and at 15 months posttreatment, he is well and asymptomatic. Although greater clinical experience must be accumulated with this new approach, intraluminal stenting following balloon dilation for recurrent carotid disease may surpass redo CEA in long-term patency and may entail fewer procedural complications.

Carotid Artery Dynamics during Head Movements: A Reason for Concern with Regard to Carotid Stenting?

“…It is applicable in high-risk patients and is not limited to the cervical carotid artery. [7][8][9] However, broad variations in success and complication rates have been reported. 1,[10][11][12][13] Despite promising early results, long-term performance may theoretically be hampered by the mobile features of the carotid artery.…”

Angioplasty and stenting for carotid artery stenosis: indications, techniques, results, and complications

“…Recent experience suggests that in this subgroup of patients the addition of stents (in the next 18 vessels) prevents the recoil phenomenon that is observed when treating more fibrous lesions. [6,12,63] The mean degree of stenosis, measured using the strict criteria developed by NASCET for calculation of de novo stenosis, [49] was 75% before and 9% after angioplasty with or without stenting in 24 of 25 treated vessels for which angiograms were available for review (angiograms were not available for one patient). No major neurological or cardiac complications occurred, and there were no deaths.…”

Stent deployment protocol for optimized real-time visualization during endovascular neurosurgery

“…3,5,6,11 As endovascular approaches are applied to more complex cases, they have increasingly relied on nuanced devices that require precise sizing, positioning, and wall apposition to function optimally.Among other challenges, endovascular approaches can be limited by suboptimal visualization during device deployment, resulting in complications and recurrent pathology. Proper device positioning, optimal wall apposition, and appreciation for coil packing density necessitate high-resolution, real-time image guidance.…”

“…3,5,6,11 As endovascular approaches are applied to more complex cases, they have increasingly relied on nuanced devices that require precise sizing, positioning, and wall apposition to function optimally.…”