J Korean Med Assoc.  2004 Jul;47(7):636-644. 10.5124/jkma.2004.47.7.636.

Endovascular Treatment of Occlusive Cerebrovascular Diseases

• Kim DI

• KMID: 2183482
• DOI: http://doi.org/10.5124/jkma.2004.47.7.636

Abstract

Carotid atherosclerosis is one the main risk factors for ischemic stroke. Based on NASCET and ECST results, carotid endarterectomy is strongly recommended for severe symptomatic stenosis. However, in the past several years, carotid artery stenting has emerged as a potential therapeutic alternative to carotid endarterectomy. The main limitation of carotid stenting is the potential risk of thromboembolic complication. Recently, cerebral protection during carotid stenting is technically feasible and clinically safe. In the published data of prospective registry with cerebral protection, the incidence of periprocedural neurologic complications was lower than in registries without cerebral protection and similar to the best results reported for carotid endarterectomy. The future status of the endovascular approach will be determined by randomized trials directly comparing carotid artery stenting with cerebral protection and endarterectomy. Occlusive atherosclerotic disease involving the intracranial cerebral vessels can be managed medically with antiplatelet and anticoagulant drug therapy or surgically. However, in patients who are unresponsive to medical therapy or who have unacceptable surgical risks, percutaneous angioplasty with stenting is an attractive alternative that can be performed in selected patients with relatively low risk and good clinical outcome.

Keyword

Atherosclerosis; Carotid arteries; Endarterectomy; Stents; Revascularization; Embolism

MeSH Terms

Angioplasty
Atherosclerosis
Carotid Arteries
Carotid Artery Diseases
Constriction, Pathologic
Drug Therapy
Embolism
Endarterectomy
Endarterectomy, Carotid
Humans
Incidence
Registries
Risk Factors
Stents
Stroke

Figure

• 

  Figure 1

• 

  Figure 2

• 

  Figure 3

Reference

1. Korea National Statistical Office. Statistical Yearbook. 2002.

2. The Korean Neurological Association. Epidemiology of Cerebrovascular diseases in Korea : a collaborative study, 1989-1990. J Korean Med Sci. 1993. 8:281–289.

3. Henrik Silesen. The natural history of patients with carotid stenosis. Pathophysiol Haemost Thromb. 2002. 32:378–380.

4. The North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991. 325:445–453.

5. The European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial : interim results for symptomatic patients with severe(70~99%) or with mild(0~29%) carotid stenosis. Lancet. 1991. 337:1235–1243.

6. Mayberg MR, Wilson SE, Yatsu F, Weiss DG, Messina L, Winn HR, et al. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. Veterans Affairs Cooperative Studies Program 309 Trialist Group. JAMA. 1991. 266:3289–3294.

7. Crawley F, Clifton A, Buckenham T, Loosemore T, Taylor RS, Brown MM. Comparison of hemodynamic cerebral ischemia and microembolic signals detected during carotid endarterectomy and carotid angioplasty. Stroke. 1997. 28:2460–2464.

8. Orlandi G, Fanucchi S, Fioretti C, Acerbi G, Puglioli M, Murri L, et al. Characteristics of cerebral microembolism during carotid stenting and angioplasty alone. Arch Neurol. 2001. 58:1410–1413.

9. Theron JG, Payelle GG, Coskun O, Huet HF, Guimaraens L. Carotid artery stenosis : treatment with protected balloon angioplasty and stent placement. Radiology. 1996. 201:627–636.

10. Cremonesi A, Manetti R, Setacci F, Setacci C, Castriota F. Protected carotid stenting; clinical advantages and complications of embolic protection devices in 442 consecutive patients. Stroke. 2003. 34:1936–1943.

11. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) : a randomised trial. Lancet. 2001. 357:1729–1737.

12. Estes JM, Donaldson MC, Whittemore AD. Stenting for carotid stenosis? N Engl J Med. 1997. 337:427–428.

13. Yadav J. Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE). 2002. Chicago, Ill: American Heart Association.

14. Reimers B, Schluter M, Castriota F, Tubler T, Corvaja N, Colombo A, et al. Routine use of cerebral protection during carotid artery stenting : results of a multicenter registry of 753 patients. Am J Med. 2004. 116:217–222.

15. Roubin GS, New G, Iyer SS, Vitek JJ, Al-Mubarak N, Kuntz RE, et al. Immediate and late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis : a 5-year prospective analysis. Circulation. 2001. 103:532–537.

16. Vitek J, Roubin G, Iyer S. Immediate and Late Outcome of Carotid Angioplasty with Stenting. 1999. 43. Nashville, Tenn: AANS/CNS/ASITN;41.

17. Henry M, Amor M, Tzvetanov K, Chati Z. A new cerebral protection device for carotid angioplasty and stenting. First clinical experience with the Percusurge Guardwire. J Endovasc Surg. 1999. 6:321–331.

18. Meyers PM, Higashida RT, Phatouros CC, Malek AM, Lempert TE, Halbach VV, et al. Cerebral hyperperfusion syndrome after percutaneous transluminal stenting of the craniocervical arteries. Neurosurgery. 2000. 47:335–345.

19. Schoser BG, Heesen C, Eckert B, Thie A. Cerebral hyperperfusion injury after percutaneous transluminal angioplasty of extracranial arteries. J Neurol. 1997. 244:101–104.

20. The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators. Design, progress and challenges of double-blind trial of warfarin versus aspirin for symptomatic intracranial arterial stenosis. Neuroepidemiology. 2003. 22:106–117.

21. Bogousslavsky J, Barnet HJM, Fox AJ, Hachinski VC, Taylor W. Atherosclerotic disease of the middle cerebral artery. Stroke. 1986. 13:1112–1120.

22. Craig DR, Meguro K, Watridge C, Robertson JT, Barnett HJ, Fox AJ. Intracranial internal carotid artery stenosis. Stroke. 1982. 13:825–828.

23. Chimowitz MI, Kokkinos J, Strong J, Brown MB, Levine SR, Furlan AJ, et al. The Warfarin-Aspirin Symptomatic Intracranial Disease Study. Neurology. 1995. 45:1488–1493.

24. Charturvedi S, Caplan LR. Angioplasty for intracranial atherosclerosis. Is the treatment worse than disease? Neurology. 2003. 61:1647–1648.

25. Lylyk P, Cohen JE, Ceratto R, Ferrario A, Mirranda C. Angioplasty and stent placement in intracranial atherosclerotic stenosis and dissections. AJNR. 2002. 23:430–436.

26. Connors JJ III, Wojak JC. Percutaneous transluminal angioplasty for intracranial atherosclerotic lesions : evolution of technique and short-term results. J Neurosurg. 1999. 91:415–423.

27. Marks MP, Marcellus M, Norbach AM, Steinberg GK, Tong D, Albers GW. Outcome of angioplasty for atherosclerotic intracranial stenosis. Stroke. 1999. 30:1065–1069.