Recanalization results after carotid stent placement

The details of stent reconstruction in the vascular lumen and of the adaptation of carotid stents, the vessel wall, and the vascular anatomy are only occasionally reported. The purpose of this study was to determine the immediate and longer-term anatomic results after implantation of self-expanding carotid stents.

In a retrospective study, pre- and postprocedural angiograms and duplex sonograms from 40 consecutive carotid stent procedures in 39 patients (22 men, 17 women; mean age, 67 years; age range, 53-84 years) with high-grade (> or =70 %) internal carotid artery (ICA) stenoses were evaluated to assess the expansion of the vascular lumen, apposition of the stent, and geometric changes in the ICA after the implantation of rolling-membrane and carotid Wallstents (n = 22) or Easy Wallstents (n = 18).

Optimal widening of the lumen and apposition of the stent were achieved in 11 (28%) of 40 arteries. Residual stenoses (n = 16), free stent filaments not attached to the vessel wall (n = 21), and stent-induced kinking of the ICA (n = 6) were minor shortcomings of stent reconstruction. Because of one death, peri-interventional morbidity and mortality rates were 3%. During follow-up (median, 24 months), one high-grade restenosis, one ipsilateral stroke, and two ipsilateral transient ischemic attacks were observed.

Suboptimal anatomic results frequently occur after endovascular treatment of atherosclerotic carotid artery stenosis with self-expanding Wallstents. With the exception of one symptomatic restenosis, no major complications or longer-term sequelae were clearly related to these findings, but further controlled follow-up studies of larger samples are required.