Elective stenting of extracranial carotid arteries.

OBJECTIVES: In symptomatic and asymptomatic patients with significant carotid artery stenosis, surgical endarterectomy has been shown to be beneficial when compared with medical management. Carotid stenting is evolving as an alternative technique for treating such patients. This prospective study was designed to assess the feasibility and safety of carotid angioplasty and stenting. METHODS: Fourteen patients (15 carotid arteries) with significant carotid artery stenosis were enrolled. These patients were in the age range 46 to 84 years (mean 60.9 +/- 7 years) and there were 12 males (86%). All of these patients were symptomatic with either TIA (n = 8) or stroke (n = 6). Wallstents were used in all the cases to stent the carotid arteries. One patient underwent bilateral carotid artery stenting. RESULTS: Carotid angioplasty and stenting was successful in 13 out of 14 (92.8%) patients and 14 out of 15 (93.3%) carotid arteries, with reduction in mean (+/- SD) stenosis from 86 +/- 6% to 3 +/- 3%. There was one episode of minor stroke, no major stroke or death during the initial hospitalization. Another patient had a minor stroke with patent ipsilateral carotid artery (on repeat angiography) during the first 30 days after the procedure. This patient was also found to have asymptomatic thrombus formation in the contralateral carotid stent which resolved with intravenous anticoagulation. During a mean follow up of 6 +/- 2 months there has been no recurrence of symptoms. CONCLUSIONS: Based upon our limited experience we believe that percutaneous carotid angioplasty with stenting is feasible with low periprocedural complication rate.

Outcomes of primary stenting for acute myocardial infarction.

Primary coronary stenting is being increasingly used in patients undergoing primary coronary angioplasty for acute myocardial infarction. In this prospective study we analysed our experience of direct angioplasty in 76 patients with acute myocardial infarction of whom 65 received intracoronary stents using high pressure deployment (> or = 12 atm) with adjunctive aspirin and ticlopidine therapy but without coumadin. All patients underwent pre-discharge angiography. Stent implantation was successful in all patients. Stent thrombosis was not seen in any patient. However, TIMI grade 3 flow was obtained in only 58 (89.2%) patients with evidence of slow-flow present in the remaining seven patients. Pre-discharge angiograms showed no-stent thrombosis but five out of the seven (71%) patients with slow-flow phenomenon persisted to have slow-flow. These patients had lower left ventricular ejection fraction as compared to patients with TIMI 3 flow at pre-discharge angiography (27.5 +/- 10.2% vs 42.1 +/- 15.2%; p < 0.001) and a high mortality (2 out of 7) within 30 days. Primary stenting is safe and feasible in the majority of patients with good short-term outcome. But persistent slow-flow phenomenon with adverse clinical outcome is seen in a small but significant number of patients.