CAROTID-ARTERY STENOSIS - TREATMENT WITH PROTECTED BALLOON ANGIOPLASTY AND STENT PLACEMENT

PURPOSE: To assess effectiveness of endovascular treatment of carotid artery stenosis by means of angioplasty with cerebral protection and s tent placement. MATERIALS AND METHODS: Angioplasty was performed for c arotid artery stenosis in 259 patients. Cerebral protection (triple co axial catheter) was used in 136 cases of atherosclerotic stenosis in t he internal carotid artery or in the carotid bifurcation and was not u sed in 123 cases. A stent was placed in 69 patients when images obtain ed immediately after angioplasty showed signs of dissection or insuffi cient arterial opening. RESULTS: No procedure-related complications oc curred in the 71 cases of nonatherosclerotic stenosis and in the 14 ca ses of proximal carotid artery and siphon atherosclerotic stenosis. Am ong the 38 patients who underwent angioplasty without cerebral protect ion, dissection occurred in two (5%) and embolic complication occurred in three (8%) during the procedure. Among 136 patients in whom cerebr al protection was used, no embolic complications occurred during angio plasty, and two (1%) occurred during or after stent placement without protection. No residual flaps were found after stents were placed, and the restenosis rate decreased from 16% to 4%. CONCLUSION: Endovascula r treatment can be considered for all types of carotid artery stenosis . Cerebral protection is mandatory to eliminate embolic complication i n cases of atherosclerotic stenosis in the internal carotid artery or carotid bifurcation. Stent placement has eliminated the risk of immedi ate dissection and reduced the risk of delayed restenosis.