Angioplasty and stenting of the extracranial carotid arteries

Purpose: To study the feasibility and safety of stent-supported angioplasty in the treatment of atherosclerotic stenoses of the extracranial carotid a rteries. Methods: Carotid angioplasty was attempted in 174 arteries (163 patients: 1 26 males; mean age: 71 +/- 10 years, range 47 to 93). Mean lesion length wa s 15.1 +/- 4.1 mm, and mean percent stenosis was 83.8% +/- 7.3% (reference diameter 5.8 +/- 0.7 mm). The majority (106, 65%) were asymptomatic (51% of all patients had severe coronary disease, 32% had peripheral vascular dise ases). Patients underwent independent neurological examination, computed to mography, duplex ultrasonography, and angiography preprocedurally, 24 hours after the procedure, and at 6-month follow-up intervals. Most (142, 82%) c arotid arteries were treated without cerebral protection, but a protective triple coaxial catheter was used in 32 (18%) patients. Stents (primarily Pa lmaz and Wallstent) were deployed routinely in all cases; 18% were implante d without predilation. Results: Immediate technical success was 173 of 174 (99.4%) (1 access failu re referred electively to surgery). Eight (4.6%) neurological complications occurred in the periprocedural period: 3 transient ischemic attacks, 2 min or strokes, and 3 major strokes (1 amaurosis and 2 hemiplegias). Two major complications developed despite cerebral protection. There were no deaths o r myocardial infarctions and only 3 cervical access site hematomas. Over a mean 12.7 +/- 9.2 month follow-up (range 1 to 36), no ipsilateral neurologi cal complications have been seen. There were 4 (2.3%) restenoses (3 redilat ed, 1 treated medically) and 1 mild Palmaz stent compression, all found wit hin the first 6 months. Primary and secondary patencies at 3 years are 96% and 99%, respectively. Conclusions: Angioplasty with routine stenting seems feasible and safe for treating certain types of carotid stenoses even in high-surgical risk patie nts; however, randomized trials are necessary before this treatment can be offered as an alternative to endarterectomy.