Early Results of Carotid Artery Stenting

Shim, Won Heum; Hong, Bum Kee; Choi, Dong Hoon; Kim, Sun Ho; Kim, Dong Ik; Kim, Seung Min; Lee, Do Yun; Chang, Byung Chul

Abstract

BACKGROUND
Surgical endarterectmy has been known to be the stendard treatment modality in management of carotid stenosis. However, endarterectomy has several limitations in high-risk patients, particulary with coronary artery disease. Percutaneous angioplasty and stenting have the patential to be less traumatic and safer, they may overcome the limitations of surgery. Early results of carotid stenting and it's safety and feasibility were analysed.
METHODS
Twenty two carotid arteries from 16 patients with significant stenosis (% diameter stenosis> or = 60%) in both symptomatic and asymptomatic patients were stented. Of the 14 patients (19 arteries) with atherosclerosis, ten patient represented which a high-risk subset with old myocardial infarction, previous coronary artery bypass graft, previous ipsilateral carotid endarterectomy, and coronary artery stenosis, and Takayasu's arteritis in 2 patients (3 arteries) Target vessels were in internal carotid arteries in 17, external in 1, and common carotid in 4. Among the 22 stents, vascular Wallstents (Schneider Co Ltd) were inserted in 19, biliary Palmaz stents (Jonhson and Johnson) in 2, and coronary Microstent II (AVE) stent in 1.
RESULTS
1) Angiographic and procedural success rates were 100%, and there were no acute or subacute stent thrombosis. 2) Immediately after initial stenting mean percent diameter reduced from 72+/-11% to 7+/-16%, and minimal luminal diameter was increased from 1.6+/-1.1mm to 4.8+/-1.8mm corresponding to an acute gain of 3.3mm. 3) Simularneous bilateral carotid stengings in 5 patients and combined stentings for coroanary and carotid arteries in 5 patients were performd. Carotid stentings were performed in 3 patients with total obstruction of contralateral carotid arteries. 4) There were no major strokes or myocardial infarctions during the procedures. There were 4 patients with contralateral total obstructions or bilateral stenosis of carotid arteries who had generalized seizures during balloon inflation; they were immediately resolved without sequele. One patient who underwent carotid endarterectomy died 3 days after stenting from intracranial hemorrhage due to uncontrolled hypertension.
CONCLUSIONS
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. This interventional measure is especially recommended in combined high risk patients such as coronary artery disease and other comorbid diseases. Larger population study and follow-up data are warranted.