Carotid artery stenting in patients at surgical high risk: Clinical and ultrasound findings

Angioplasty and stenting (A/S) provide an alternative for patients with sim ultaneous severe cardiac and cerebrovascular disease, or with medical illne sses which carry a high perioperative risk. We conducted A/S in 20 high-ris k patients (15 males, 5 females, mean age = 64.5 years, range = 49-83 years ) with symptomatic (n = 16) and asymptomatic (n = 4) high-grade stenosis (> 70%, NAS-CET criterion) of the internal carotid artery. Patients had neurol ogical examinations before, during and after the procedure. Color-coded dup lex sonography was performed before and 24 h and every 3 months after the p rocedure; the 3-month examination also included cerebral angiography. The m ean degree of stenosis was reduced from 85.75 +/- 7.47 to 8.0 +/- 22.09% in angiography. In an 18-month follow-up with color-coded duplex sonography t he effects of the AIS could be visualized effectively: 2 with local, transi ent vasospasms, 1 with asymptomatic occlusion, 2 carotid arteries with rema ining stenosis of 50% and 2 with minimal hyperplasia within the stent, In c onclusion, in patients with a high perioperative risk, AIS is a therapeutic alternative to surgery. Copyright (C) 2000 S. Karger AG, Basel.