PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND STENTS IN THE TREATMENT OF EXTRACRANIAL CIRCULATION

A feasibility study of stent supported angioplasty for the extracrania l occlusive disease was conducted to include the carotid bifurcation a nd the internal carotid artery. One hundred seventy-four patients have undergone extracranial PTA and/or stenting for occlusive disease invo lving the great vessels off the aortic arch, including the internal ca rotid. Sixty-one of the patients represented carotid occlusive disease , of which which 15 were managed by PTA and 46 by intravascular Johnso n & Johnson Interventional Systems stents. There were 13 vertebrals in the group, 7 innominate, 81 subclavian, 10 axillary lesions, and 2 gr afts, 1 of which was an internal carotid interpositioned vein graft. T he 61 patients that had carotid angioplasty and/or stents had a compli cation rate of 8%. However, 46 patients had a primary stenting procedu re. From this group, 2 patients had minor strokes involving the upper extremities. One patient recovered fully within 24 hours, and the othe r had an 85% recovery at the end of a 1-week interval. Two patients en countered transient ischemic attacks. There were no deaths, and no maj or disabling strokes in the carotid series. The follow-up for the caro tid stent group had a mean duration of only 2.5 months. Twenty-nine of the patients have been reevaluated with no new onset of neurological sequelae. There were no stent deformations noted as evaluated by three -dimensional computed tomographic angiography and color flow Doppler i n addition to magnificant radiography. All patients have had 24-hour p ostoperative and 1-month color flow Doppler. All patients are required by protocol to undergo angiographic evaluation. If we include all ext racranial interventions (174), a technical success of 93% was achieved in those patients undergoing PTA and 94% of those patients undergoing stenting procedures. Suboptimal results were obtained in 6% of the PT A procedures, and 0% for stents. There is now sufficient data to docum ent the efficacy of managing managing extracranial occlusive disease b y percutaneous endovascular stents. The exception, however, is the car otid bifurcation and the internal carotid artery, where a well-control led feasibility study with careful analysis of the data will be necess ary prior to randomizing the study against the gold standard of caroti d endarterectomy.