J Korean Soc Radiol.  2011 Oct;65(4):365-372. 10.3348/jksr.2011.65.4.365.

Preliminary Report of Carotid Artery Stenting Using a Tapered Stent

• Jeong CW
• Kim DH
• Ahn SH
• Kim DU
• Hong SJ
• Kim YS
• Byun JN
• Oh JH

• KMID: 2002937
• DOI: http://doi.org/10.3348/jksr.2011.65.4.365

Abstract

PURPOSE
To analyze the results of carotid artery stenting using a tapered stent and to evaluate the effectiveness of the tapered stent compared to previously reported studies using non-tapered stents.
MATERIALS AND METHODS
From October 2008 to August 2010, elective carotid artery stenting using a tapered stent was attempted in 39 lesions from 36 consecutive patients. Post-procedural complications were evaluated by neurologic symptoms and magnetic resonance imaging. Restenosis or occlusion was evaluated by carotid Doppler ultrasound and computerized tomography with angiography. Newly developed neurologic symptoms were evaluated clinically.
RESULTS
The self-expandable tapered stent was placed across the carotid artery stenosis. A total stroke was noted in 3 patients, while a major stroke was noted in 1 patient. On diffusion weighted imaging, new lesions were observed in 15 patients, but 13 patients were clinically silent. Follow-up imaging studies were performed in the 13 clinically silent lesions, and no evidence of restenosis or occlusion was found any of the 13 lesions. During clinical follow-up in 34 lesions from 31 patients, there were newly developed neurological symptoms in only 1 patient.
CONCLUSION
Carotid artery stenting using a tapered stent may be safe and useful for the treatment of carotid artery stenosis.

MeSH Terms

Angiography
Angioplasty
Carotid Arteries
Carotid Stenosis
Diffusion
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Neurologic Manifestations
Stents
Stroke

Figure

• 

  Fig. 1 In a 67-year-old woman patient, MRI shows focal stenosis at the right carotid bulb and complete occlusion of a left internal carotid artery (arrow) (A). 3D digital subtraction angiography before the procedure shows focal stenosis with ulcerated plaque at the right carotid bulb (arrow) (B). Post-procedural angiography shows well conformable stent structure (C). Post-procedural diffusion weighted-MR image shows newly developed high signal intensity in left middle cerebral artery territory (D). Surgical repair of abdominal aortic aneurysm was performed at 1 month after carotid artery stenting. Post-operative diffusion weighted-MR images shows high signal intensity in anterior inferior cerebellar artery territory, both and left middle cerebral artery territory (E, F).

• 

  Fig. 2 Diffusion weighted-MR image of a 69-year-old man with severe stenosis of right carotid artery. A, B. Compared with pre-procedural image (A), post-procedural diffusion weighted-MR image (B) shows high signal intensity in right parietal lobe (arrow), the patient had neurologic symptoms such as left hemianopsia and left tactile neglect, but the neurological symptoms completely disappeared within 5 days.

• 

  Fig. 3 Post-procedural follow-up studies of a 59-year-old man with severe stenosis of left carotid artery (A, B) and a 69-year-old man with severe stenosis of carotid artery (C, D, E). Computerized tomography with angiography (A, B) and carotid Doppler ultrasound (C, D, E) show no restenosis.

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