[Quality criteria in using percutaneous transluminal angioplasty of supra-aortic arteries]

On the basis of 252 personally performed angioplasties and almost 2000 published results of percutaneous transluminal angioplasties (PTA) in supra-aortic arteries quality criteria for PTA in supra-aortic arteries are to be elaborated with special reference to the carotid artery.

To keep the complication rates low the indication must be strictly observed and particular attention paid to the morphological criteria. Experience has shown that PTA should be applied in brachiocephalic arteries only in the presence of symptomatic, high-grade, circular or short stenosis and smoothwalled stenosis without ulceration or severe calcification. In support of the angiography, intravascular ultrasound tomography is recommended for therapy control to ensure the quality. The application of stents is only useful when the result of the angioplasty is suboptimal and dissections and/or intimal flaps can be detected. Occlusion of the subclavian artery should be dilated by primary stent application. Quality can be assured by the use of modern instruments including investigational systems. The proper performance of angioplasty necessitates monitoring by means of EEG and ECG as well as close supervision of the pressure applied for dilatation. The quality and the documentation of the angioplasty results are ensured by post-therapeutic controls using angiography, intravascular ultrasound tomography and cerebral computer tomography. Good long-term success can only be achieved with the aid of post-therapeutic oral anticoagulant therapy. Application of angioplasty in supra-aortal arterial obliteration can result in an average morbidity of 0.9% with no or only minimal lethality if the necessary quality criteria are observed.

Whereas percutaneous transluminal angiography of the subclavian artery and the vertebral artery can be regarded as the therapy of choice, the results of prospective multicentre studies will have to be awaited before it can be assigned a place in carotid angioplasty.