Atenosis and occlusion of the supraaortic vessels - interdisciplinary interventional treatment of patients with increased operation risks

Purpose. The value of elective PTA in stenoses of the supraaortic vessels a nd especially of the carotid artery is still under discussion. Stenoses aft er surgical and/or radiation therapy and a high cardio-vascular risk for a surgical procedure, however, justify minimal-invasive techniques. Material and methods. In 31 patients with 24 symptomatic and 7 asymptomatic stenoses of the supraaortic arteries (3 Acc, 19 Aci, 5 Asci, 4 Tr. brc, 2 Aax) minimal-invasive angioplasty and stent-placement was performed. The ra tionale for the interventional procedure was an elevated medical or technic al risk of the respective surgical procedure. All procedures were performed using a coaxial technique with a guiding catheter. An open vascular access was necessary in 7 cases due to an unfavorable anatomical situation. Results. The technical success rate was 100%. Peri-interventionally, a TIA occurred in 2 patients(1 spontaneous releave, 1 complete remission after rt -PA lysis thera py). During the mean follow-up period of 13 months 3 patien ts died due to non-cerebrovascular reasons. In 2 patients a moderate resten osis, in 1 a high-grade stenosis,and in 1 and complete occlusion occurred w ithout symptoms. After one year of follow-up, all treated stenoses were pat ent with a restenosis rate of 10.7% without further neurological symptoms. Conclusion. Interventional angioplasty with stent-placement of the supraaor tic arteries is a safe and effective alternative in patients are at high ri sk for classical surgical procedures.