Percutaneous carotid stenting: a novel treatment for carotid artery stenosis

Stroke is currently a leading cause of physical disability and carries a high mortality rate. About 20% of ischemic stroke is caused by carotid artery stenosis. Carotid stenting is now another therapeutic modality for the treatment of extracranial carotid artery stenosis.

All patients who underwent carotid stenting at King Chulalongkorn Memorial Hospital from March 2001 to December 2002 were analyzed. The case success was determined by residual angiographic stenosis of less than 30% without any major adverse cardiovascular events such as death, stroke or emergency re-intervention.

Carotid stenting was performed in 6 patients with 9 vessels disease. Their mean age was 71.8 years. Hypertension was the most common risk factor detected in all patients, followed by smoking (83.3%), dyslipidemia (83.3%) and diabetes (33.3%). One third of the patients had a prior history of stroke or transient ischemic attack and 16.6% occurred within 6 months. Five of six (83.3%) had severe coronary disease and required coronary artery bypass grafting after successful carotid stenting. The procedures were successful in all patients. The average percent of stenosis was reduced from 83.2% to 9.4%. The distal protection device was used in one-third of the cases. The average procedure time was 63.6 minutes and fluoroscopic time was 16.6 minutes. There was no evidence of stroke or death after the procedures. Only one (11.1%) developed hypotension and bradycardia that required intravenous fluid loading and inotropic support for 24 hours.

Carotid stenting at our center is feasible and considered to be a safe procedure for the treatment of carotid artery stenosis. This procedure is another alternative treatment and may be superior to carotid endarterectomy, the standard treatment of carotid artery stenosis.