Stenting of Extracranial Carotid Artery Stenosis

Abstract

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.