Endovascular Stents for Carotid Artery Occlusive Disease

Abstract

Purpose: To study the feasibility and safety of endovascular stenting of cervical carotid artery stenosis. Methods: Between April 1994 and May 1997, 108 consecutive patients (58 men; mean age 70.1 years) with ≥ 70% carotid stenosis were treated with percutaneous stent implantation under a protocol that featured independent neurological review. Forty-four percent were asymptomatic. Over half the lesions (59%) were in the internal carotid artery; the mean stenosis was 86%. Palmaz stents were implanted without cerebral protection following preliminary balloon dilation; two Wallstents were used in long lesions. Results: Carotid stents were successfully placed in 108 of 114 (95%) lesions. Of the 6 technical failures, 5 were access related and 1 was due to seizures during balloon dilation. Two major (1.8%) and 2 minor (1.8%) strokes occurred (3.7% stroke rate for 108 patients; 3.5% in 114 procedures), all in symptomatic patients, one of whom died. There were 5 (4.4%) transient ischemic attacks and 2 (1.8%) brief seizure episodes during dilation. One patient died of a cardiac event on day 20. The all stroke or death rate was 5.3% based on 114 arteries at risk (5.6% in 108 patients). In the mean 6-month follow-up (range 1 to 36) of 97 eligible patients, 3 (3.1%) died from unrelated causes. There was 1 restenosis (1.0%) from a stent compression, which was successfully redilated. There were no neurological sequelae, cranial palsies, or cases of stent or vessel thrombosis in follow-up. Conclusions: The use of stents in the treatment of cervical carotid occlusive disease appears feasible, effective in the short term, and without excessive risk of periprocedural stroke.

Systematic Review of Early Recurrent Stenosis After Carotid Angioplasty and Stenting

“…10,16,17,[23][24][25][26][27]29,31,35,37,39,42 Twenty-five studies used a lower restenosis threshold Ն50% to 70%, 10 -34 whereas 16 studies used a lower threshold Ͼ70% to 80% to define a restenosis. 10,11,14,15,17,19,21,[35][36][37][38][39][40][41][42][43] In Figure 1, the proportion of patients/arteries in whom/ which restenosis developed is plotted against the average follow-up time. In both groups, the data were very heterogeneous ( 2 ϭ83, dfϭ24 in the restenosis group Ն50% to 70%, PϽ0.01; and 2 ϭ39, dfϭ15 in the restenosis group Ͼ70% to 80%, PϽ0.01).…”

“…10,11,[15][16][17]19,21,39,40,42,43 In both groups, Ϸ46% of all restenoses occurred within the first 6 months, Ϸ25% within 6 to 12 months, and 29% beyond the first year.…”

“…However, of the 34 studies, only 24 studies provided ipsilateral stroke rates for both patients with and without recurrent stenosis. 10 -13,15,19,20,22-26,28,29,31-34,37-39,41-43 Moreover, the number of ipsilateral strokes was zero in both the restenosis and no restenosis groups in 15 studies, 10,13,15,20,24,26,29,31,33,34,37,39,[41][42][43] zero in the restenosis group in 6 studies, 12,19,22,23,28,32 and zero in the no restenosis group in 3 studies. 11,25,38 Therefore, the data were insufficient to calculate a valid summary estimator of the relative risk of stroke in patients with recurrent stenosis compared with patients without recurrent stenosis.…”

Carotid Stenting and Endarterectomy

“…In the last decade, however, the introduction of adjunctive stenting has mitigated many of these concerns. Although it is still an emerging technique using evolving equipment, both single-center reports [22][23][24][25][26] and worldwide surveys 27 of carotid stenting have demonstrated procedural results approaching those of endarterectomy, typically in high-risk patients with significant comorbidities excluded from previous surgical trials. 28 -33 Complications of anesthesia, infection, hemorrhage, myocardial infarction, and cranial nerve palsy are avoided with stenting, which has also shown the potential to shorten hospital stays and lower costs compared with endarterectomy.…”

A Rare Complication of Carotid Artery Stenting: Displacement of Marker Ring Causing Locking of Stent and Incomplete Stent Expansion

“…Less common complications during CAS placement are hemodynamic conditions such as bradycardia and hypotension, which are easily treatable. [1][2][3] Mechanical complications such as spasm or dissection are seen less and less frequently with personal experience and innovations in equipment. Complications caused by unlucky mechanical accidents during stent implantation such as incomplete opening are unusual and therefore can be a reason for unpredictable outcomes of CAS placement.…”