[Primary stent implantation in the internal carotid artery]

Advances in interventional catheter technology have made it possible to dilate stenoses also in the internal carotid artery (ICA). This may cause cerebral emboli, but primary stent implantation may fixate atherosclerotic material on the vessel wall and thus prevent embolization.

Marked stenosis in the ICA was treated by balloon dilatation in 71 consecutive patients aged between 40 and 85 years (mean 69 +/- 9 years). If possible, a stent was implanted before the first balloon dilatation.

A stent was placed before dilatation in 53 of 76 procedures. Dilatation with a small balloon to allow stent placement was necessary in 23. Thus stent implantation before definitive dilatation was successful in all instances. 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 infarction 2 days after the procedure. Thus the neurological complication rate was 3.9% and the death rate 1.3%. Follow-up examination revealed an asymptomatic occlusion of the ICA after two weeks in one patient, a recurrent stenosis after 6 months in two of 46 patients. In all other patients the degree of stenosis was less than 50% at 6 months.

Primary stent placement before balloon dilatation in ICA stenosis was possible in the majority of patients. This procedure would thus seem to reduce the risk of thromboembolic complications.