Primary stent implantation in the internal carotid artery

Background and objective: Advances in interventional catheter technology ha ve made it possible to dilate stenoses also in the internal carotid artery (ICA). This may cause cerebral emboli, but primary stent implantation may f ixate atherosclerotic material on the vessel wall and thus prevent emboliza tion. Patients and methods: Marked stenosis in the ICA was treated by balloon dil atation in 71 consecutive patients aged between 40 and 85 years (mean 69 +/ - 9 years). If possible, a stent was implanted before the first balloon dil atation. Results: A stent was placed before dilatation in 53 of 76 procedures. Dilat ation with a small balloon to allow stent placement was necessary in 23. Th us stent implantation before definitive dilatation was successful in all in stances. The degree of stenosis was reduced from 79 +/- 11 to 9 +/- 14%. In all procedures the stenosis was reduced to less than 50%. One patient had a severe and two had a mild stroke. One patient died of a myocardial infarc tion 2 days after the procedure. Thus the neurological complication rate wa s 3.9% band the death rate 1.3%. Follow-up examination revealed an asymptom atic occlusion of the ICA after two weeks in one patient, a recurrent steno sis after 6 months in two of 46 patients. In all other patients the degree of stenosis was less than 50% at 6 months. Conclusion: Primary stent placement before balloon dilatation in ICA stenos is was possible in the majority of patients. This procedure would thus seem to reduce the risk off thromboembolic complications.