ABSTRACT
Patients with symptomatic > or = 60% (n = 134), asymptomatic > or = 80% (n = 143), and asymptomatic progressive > or = 60% (n = 25) internal carotid artery stenosis underwent stenting and were followed clinically and by Doppler-assisted duplex imaging for 27.1 +/- 15.6 months. Stroke and death from stroke occurred within 30 days after stenting in 4.7% of the symptomatic and in 3.0% of the asymptomatic patients and in the follow-up period in 2.3% of the symptomatic and in 1.2% of the asymptomatic patients.
Subject(s)
Carotid Artery, Internal/surgery , Carotid Stenosis/surgery , Intracranial Embolism/etiology , Stents/adverse effects , Stroke/prevention & control , Vascular Surgical Procedures/adverse effects , Age Factors , Aged , Aged, 80 and over , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/pathology , Causality , Disease-Free Survival , Female , Follow-Up Studies , Graft Occlusion, Vascular , Humans , Intracranial Embolism/prevention & control , Male , Middle Aged , Patient Selection , Postoperative Complications , Reoperation/statistics & numerical data , Time , Treatment Outcome , Ultrasonography, Doppler, DuplexABSTRACT
The treatment of carotid stenoses with balloon angioplasty and stenting is a new and not generally established method. During a one year period 65 patients (22 female, 43 male, mean age: 73 years, 47 with neurologic symptoms, 8 with contralateral carotid occlusion) with significant (>70%) carotid stenosis were treated with balloon angioplasty and balloon expandable stents. The primary technical success rate was 98% (65/66 patients) respectively 99% (69/70 stenoses). A combined procedure was performed in 11 /17%) patients with stenting in both carotid arteries in 4 patients with additional coronary interventions in 6 patients and stenting of the origin of the common carotid artery in one patient.Severe neurologic complications occurred in 4 (6.2%) patients (1 death, 1 major stroke, 2 minor strokes) and short lasting neurologic deficits in additional 4 (6.2%) patients. Cardiovascular complications were not observed. Local (inguinal) problems occurred in 3 (4.5%) patients (2 aneurysma spuria, 1 transfusion for hematoma). Frequently, balloon insufflation was associated with bradycardia (40%) and additional hypotension (11%). In summary, carotid stenting can be performed with technically high success rates (99%), but it is adversely influenced by not infrequent thromboembolic cerebral events (12.4%). The possibility to perform combined procedures with interventions in other vessels (both carotid arteries, coronary arteries, aortic arch arteries) is advantageous.
