Stenting therapy for extra-cranial carotid stenosis

We report our initial results of stent placement for extra-cranial carotid stenosis. Fifteen patients aged 54 to 83 years (10 men) with > 60% extra-cranial carotid stenosis were treated with percutaneous stent implantation. Four patients were asymptomatic. The rate of stenosis ranged from 60% to 93% (mean: 74%). Balloon-expandable stents (Palmaz stent: 11, Cordis stent: 1, GFX stent: 2) were placed for fourteen patients and for one patient a self-expandable stent was used (Memotherm biliary stent). The proximal protective balloon technique was used in the most possible cases during predilatation or stent placement. Angiography or ultrasonography was performed as the evaluation of restenosis after stent placement. The definition of restenosis was > 50% stenosis. The mean period of follow-up was 8.5 months (from 1 to 20 months). In all patients, carotid stents were successfully placed. The mean rate of stenosis immediately after the procedure decreased to 0%. The protective balloon technique could be used in ten patients during pre-dilatation, in six during stent placement. One patient suffered a transient ischemic attack immediately after predilatation. The symptoms disappeared completely 15 minutes after onset. There was no patient with relapse or deterioration of neurological deficits after the procedure. There was no restenosis and stent deformation in the follow-up period. In our small series, stent placement for extra-cranial carotid stenosis was performed with a low rate of morbidity and mortality. However, it is necessary to develop more flexible, more controllable stents with increased mesh densities for exclusive neurointervention. In addition, the development of a more reliable protective balloon technique to decrease procedurerelated complications is needed.