INTERVENTIONAL TREATMENT OF CAROTID-ARTER Y STENOSIS

Background and objective: The therapeutic efficacy of carotid thromben darterectomy (TEA) for high-grade symptomatic or asymptomatic carotid stenosis is considered as proven. But in many centres percutaneous tra nsluminal angioplasty (PTA) has become an ever more frequent alternati ve to operation. This report concerns 34 cases of carotid PTA, most of them in conjunction with stent implantation. Patients and methods: Be tween September 1994 and December 1996, a total of 34 percutaneous tra nsfemoral angioplasties (similar technique to coronary angioplasty) fo r carotid stenosis was performed in 30 patients (six women, 24 men; me an age 66 +/- 11 years). PTA alone was undertaken in the first eight i nterventions, PTA together with primary stent implantation in the rema ining 26. Results: With one exception (PTA only) all interventions (in cluding stent implantation) were successful with good primary angiogra phic results. The dilatation decreased the luminal stenosis from a mea n of 83.4% (+/- 9.9%) of vessel diameter to 13.0 (+/- 12.4%). Complica tions were a stent occlusion with prolongated ischaemic neurological d eficit, completely reversed within 2 days, in one patient and transito ry ischaemic attacks in two others. Conclusion: Experience to-date ind icates that PTA with stent implantation in the carotid artery is a sat isfactory alternative to carotid TEA, especially in patients with an i ncreased operative risk.