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Cervical carotid artery stenosis: which technique, balloon angioplasty or surgery?
P Bergeron1, P Chambran, O Hartung
1St. Joseph Hospital Foundation, Marseilles, France.
Insights
Primary stenting for cervical carotid stenosis showed better results than balloon angioplasty, which had a high neurologic risk. Conventional surgery remains the gold standard for complex cases.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiovascular Research
Background:
- Cervical carotid stenosis poses a significant risk of stroke.
- Treatment options include conventional surgery, balloon angioplasty, and stenting.
- Evaluating the safety and efficacy of different endovascular techniques is crucial.
Purpose of the Study:
- To compare the outcomes of balloon angioplasty (BA) versus primary stenting in treating cervical carotid stenosis.
- To assess the neurologic risks associated with each endovascular procedure.
Main Methods:
- Retrospective analysis of 38 patients treated for cervical carotid stenosis between 1991 and 1995.
- Patients were divided into two groups: 19 treated with BA and 19 with primary stenting.
- Complex lesions were managed with conventional surgery.
Main Results:
- The balloon angioplasty group experienced one death from intracerebral hemorrhage, one reversible stroke, and three TIAs.
- The primary stenting group had no reported complications or silent infarcts on CT scans.
- No hematomas required surgical intervention in either group.
Conclusions:
- Primary stenting appears to be a more reliable treatment for cervical carotid stenosis compared to balloon angioplasty.
- Balloon angioplasty is associated with a higher neurologic risk.
- Conventional surgery remains the gold standard, with further follow-up needed to assess restenosis rates.
Methods:
Between April 1991 and November 1995, 38 patients mean age 65 (6 females, 32 males) were treated by cervical puncture for isolated cervical carotid stenosis (33 internal, 1 external, and 6 common carotid). All patients but 5 were symtomatic (19 TIA, 7 amarosis, 2 strokes and 4 VB symptoms). Complex lesions involving the carotid bifurcation and heavy calcifications were treated by conventional surgery. Two different groups of patients were considered. A first group of 19 patients (17 restenosis, 1 primary, 1 FM dysplasia) was treated by simple balloon angioplasty (BA). A second group of 19 patients was treated by primary stenting (16 DF NOVO, 2 radio-induced, and 2 recurrent stenosis).
Results:
No hematoma required surgery. In the first group one patient died from an intracerebral hemorrhage, one presented a reversible stroke and 3 others a TIA. In the second group there was no complication or silent infarction on the CT SCAN:
Conclusions:
Balloon angioplasty appears to be associated with a high neurologic risk. While primary stenting seems much more reliable. A longer follow-up to deal with restenosis. Conventional surgery remains the gold standard.