Angiographic Characteristics of Pseudo-occlusion of the Internal Carotid Artery Before and After Stenting.

BACKGROUND: Various definitions of pseudo-occlusion and clinical outcomes after various treatments have been reported, but reports discussing the stenotic characteristics of pseudo-occlusion are rare. OBJECTIVE: To analyze the angiographic characteristics of pseudo-occlusion of the internal carotid artery (ICA) before and after carotid artery stenting (CAS). METHODS: We retrospectively reviewed the angiographic characteristics of 56 patients with pseudo-occlusion of the ICA treated with CAS. Angiographic changes were evaluated from digital subtraction angiography in terms of lesion characteristics of the stenosis and the diameter changes in the distal ICA before and after CAS. RESULTS: Fifty-six patients were successfully treated. Based on angiographic findings of ICA stenosis, 33 and 23 patients were classified into the single-channel and multiple-channel group, respectively. Regarding the diameter changes in the distal ICA after CAS, 31 cases were classified as immediate dilatation and the other 25 as restricted dilatation. Immediate dilatation of the distal ICA beyond the stent and that at a follow-up examination were observed significantly less frequently in the multiple-channel group than in the single-channel group. The use of multiple stents and stent occlusion at a follow-up examination were significantly more prevalent in the multiple-channel group than in the single-channel group. CONCLUSION: Stenotic lesions of pseudo-occlusion of the ICA were classified as single channel and multiple channel. Restricted dilatation of the distal ICA after CAS was more prevalent in the multiple-channel group. Because adverse events tended to be more frequent in the multiple-channel group than in the single-channel group, the indications for CAS should be determined carefully in multiple-channel patients. ABBREVIATIONS: CAS, carotid artery stentingICA, internal carotid artery.

The clinical results of transcervical carotid artery stenting and frequency chosen as the approach route of carotid artery stenting in 1,067 consecutive cases.

BACKGROUND: Carotid artery stenting (CAS) is generally performed via a transfemoral approach. A transbrachial approach is usually chosen as an alternative when CAS via a transfemoral approach is difficult. At our institutions, a transcervical approach is chosen when the previous two approach routes are not available. We reviewed CAS cases treated via the transcervical route in our 1,067 CAS series to investigate the safety, feasibility, and frequency of this procedure as an approach route of CAS. METHODS: We performed 1,067 CAS procedures in 1,067 consecutive cases between December 2002 and June 2011. Initially, a transfemoral route was chosen, and secondarily a transbrachial route, the last choice was a transcervical route. A transbrachial approach was chosen in 96 (9.0%) cases and a transcervical approach in ten (0.9%). We reviewed the characteristics and outcomes of CAS performed via a transcervical approach. RESULTS: CAS was successfully performed on all ten transcervical-approach patients. Eight procedures were performed under local anesthesia and two under general anesthesia. Perioperative morbidity and mortality were both 0%. The modified Rankin scale (mRS) showed no deterioration at 3 months except for one case whose mRS became five because of an embolic stroke after aortic valve replacement. CONCLUSIONS: CAS via a transcervical approach was safe and feasible, and its frequency chosen as an approach route was 0.9%. This procedure can be an alternative to transfemoral or transbrachial approaches when CAS via either of these approaches is too difficult.