[Carotid percutaneous transluminal angioplasty in cardiological patients with increased surgical risk]

Carotid angioplasty is a revascularisation procedure introduced more than 20 years ago and that is still not widely accepted. Most institutions perform this intervention only under a study protocoll or in patients with high risk for carotid surgery. We performed angioplasty of the extracranial internal carotid artery in 50 patients with increased risk for surgery: 43 men, 7 women, 19 older than 75 years, 42 with significant coronary artery disease and 25 prior to CABG. Eight patients presented with an LVEF < 40%, 13 were neurologically unstable, 6 had a recurrence after endarterectomy and 1 patient had a lesion induced by radiotherapy. After predilatation with a 3.5 mm balloon via 8 F guiding catheter we implanted 21 JJ biliary stents, 25 Jostent Carotid, 2 Wallstents und 4 coronary stents.

47/50 patients were dilated successfully with a reduction of the stenosis from 82 +/- 12% to 6 +/- 8%. Three patient experienced a severe acute complication: 1 severe intracerebral bleeding after 5 hours, most likely due to abciximab, and 2 minor cerebral strokes. After 6 months 1 patient had died after CABG, 1 patient experienced a TIA and another developed restenosis (2.4%).

Carotid angioplasty with stenting is a valuable alternative to Carotis-TEA or medical therapy, especially in patients with significant comorbidity, who present with increased risk for vascular surgery.