Endovascular repair of external carotid artery disease

To review the literature on the endovascular management of external carotid artery (ECA) disease.

A review was conducted of the English-language medical literature from 1985 to 2011 using PubMed, OVID, and EMBASE databases to find all studies involving endovascular management of ECA stenosis. The search identified 21 reports describing endovascular repair of ECA lesions encompassing 56 patients (35 men; mean age 62.6±10.5 years) and 58 arteries.

The majority of patients (91.1%) were reported to have ipsilateral ICA occlusion, while 55.6% of patients were symptomatic. In the 56 patients, 33 arteries received stents primarily, while 25 had primary balloon angioplasty; 52 cases involved endovascular repair of ECA stenosis, while 4 patients with a normal ECA had a covered stent deployed to exclude the ICA stump. The technical success rate was 98.3%. During the first 30 days after the procedure, 1 (1.8%) stroke was reported, while 5 (8.9%) transient ischemic attacks were also described. During a follow-up period spanning an average 23.8±18.3 months, none of the patients experienced any clinical cerebrovascular event. Two (3.4%) dilated ECAs developed restenosis, while 1 (1.7%) ECA stent occluded at 6 months.

Endovascular repair of ECA appears to have low rates of perioperative stroke or death but a high rate of TIAs. The appropriate type of stent and the use of embolic protection need to be established. In the endovascular era, despite the limited data available, this therapeutic approach could be considered a reasonable alternative to conventional open repair, especially in patients with ipsilateral ICA occlusion and concomitant contralateral carotid stenosis or occlusion, an insufficient circle of Willis, and other significant comorbidities.