EVOLVING INDICATIONS FOR AND EARLY RESULTS OF CAROTID-ARTERY STENTING

BACKGROUND: While carotid endarterectomy continues to be the gold stan dard of treatment for most patients with significant carotid artery di sease, there are cases where lesion or anatomy-related factors create situations less than ideal for conventional surgery. Other therapeutic modalities, such as endoluminal stenting, may represent reasonable op tions for such patients. METHODS: Thirty-three patients with 70% or gr eater internal carotid artery lesions were treated by endovascular ste nt placement from July 1994 through June 1996. Indications included tr ansient ischemic attacks in 20 and previous stroke in 4; and 9 were as ymptomatic. RESULT: Stents were placed successfully in all instances. Mortality and stroke rates were zero. All patients remained asymptomat ic during follow-up (mean 8 months), and stent patency by duplex ultra sound has been 100%. A single instance of intrastent restenosis has be en observed. CONCLUSIONS: Endoluminal stenting is an investigational t echnique of unproven efficacy and longterm durability. Yet it appears technically feasible, and possibly reasonable, as an alternate option for cases unfavorable for standard surgery. (C) 1997 by Excerpta Medic a, Inc.