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Published on: May 9, 2013
Internal carotid artery stenting in patients with symptomatic atheromatous pseudo-occlusion
Alberto Gil-Peralta1, Alejandro González, José R González-Marcos
1Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain. golperal@cica.es
Insights
Atherosclerotic pseudo-occlusion (APO) of the internal carotid artery (ICA) is challenging to diagnose. Angioplasty and stenting offer a potential treatment, but its effectiveness and safety for APO require further investigation.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Atherosclerotic pseudo-occlusion (APO) of the internal carotid artery (ICA) is an underrecognized condition.
- Diagnostic challenges exist with noninvasive methods and angiography.
- Management remains controversial due to poorly characterized natural history.
Purpose of the Study:
- To report the results and complications of angioplasty and stenting in patients with ICA-APO.
- To address the appropriate management of patients with ICA-APO.
Main Methods:
- Retrospective analysis of angioplasty and stenting procedures in patients with ICA-APO.
- Evaluation of procedural success, complications, and clinical outcomes.
Main Results:
- Results of angioplasty and stenting in ICA-APO patients have not been previously published.
- This study presents the initial findings for this specific patient group.
Conclusions:
- Angioplasty and stenting may be an option for specific ICA-APO cases, particularly in high-risk surgical patients.
- Further research is needed to establish the long-term efficacy and safety of this intervention for APO.
Abstract:
Angioplasty and stenting of the atheromatous internal carotid artery (ICA), besides in patients with a high surgical risk, may be indicated in specific cases such as contralateral occlusion, acute stroke clinical signs, or atherosclerotic pseudo-occlusion (APO). APO of the ICA is an underrecognized condition due to diagnostic difficulties both with noninvasive methods and even with angiography. Once recognized, there is usually the opportunity for successful revascularization with carotid endarterectomy. However, as the natural history of the APO is poorly characterized, the management of patients remains controversial. While some authors advocate a surgical approach, others consider that APO patients are not at high risk of stroke, making any interventional approach unnecessary. The perioperative risk of stroke in patients with APO is not appreciably greater than in patients with lesser degrees of stenosis and clear recommendation of surgery, although at 2 years that risk seems to be considerably much higher than in the latter patients. Looking for safer interventional procedures is worthwhile. Results of angioplasty and stenting in patients with ICA-APO have not been published yet. We report the results and complications associated with this procedure to address the issue of appropriate management of patients with ICA-APO.