Related Experiment Videos
Endovascular stents for carotid artery occlusive disease
M H Wholey1, M H Wholey, C R Jarmolowski
1Department of Interventional Radiology, Louisiana State University Medical Center, New Orleans 70121, USA.
Insights
Endovascular stenting is a feasible and safe treatment for cervical carotid artery stenosis. This procedure showed a low rate of stroke and death, making it an effective option for patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Cervical carotid artery stenosis poses a significant risk of stroke.
- Endovascular interventions are increasingly explored as alternatives to traditional surgical management.
- Assessing the safety and efficacy of carotid artery stenting is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the feasibility and safety of endovascular stenting for cervical carotid artery stenosis.
- To determine the periprocedural complication rates, including stroke and death.
Main Methods:
- A cohort of 108 consecutive patients with > or = 70% carotid stenosis underwent percutaneous stent implantation between April 1994 and May 1997.
- Procedures involved preliminary balloon dilation followed by Palmaz or Wallstent implantation without routine cerebral protection.
- Independent neurological review was integral to the study protocol.
Main Results:
- Successful stent placement was achieved in 95% of lesions (108/114).
- The overall stroke or death rate was 5.3% (5.6% in patients), with all strokes occurring in symptomatic individuals.
- Follow-up revealed a low restenosis rate (1.0%) and no instances of neurological sequelae, cranial palsies, or thrombosis.
Conclusions:
- Endovascular stenting is a feasible and effective short-term treatment for cervical carotid occlusive disease.
- The procedure demonstrated an acceptable risk profile regarding periprocedural stroke.
- Stenting offers a viable therapeutic option for selected patients with carotid stenosis.
Purpose:
To study the feasibility and safety of endovascular stenting of cervical carotid artery stenosis.
Methods:
Between April 1994 and May 1997, 108 consecutive patients (58 men; mean age 70.1 years) with > or = 70% carotid stenosis were treated with percutaneous stent implantation under a protocol that featured independent neurological review. Forty-four percent were asymptomatic. Over half the lesions (59%) were in the internal carotid artery; the mean stenosis was 86%. Palmaz stents were implanted without cerebral protection following preliminary balloon dilation; two Wallstents were used in long lesions.
Results:
Carotid stents were successfully placed in 108 of 114 (95%) lesions. Of the 6 technical failures, 5 were access related and 1 was due to seizures during balloon dilation. Two major (1.8%) and 2 minor (1.8%) strokes occurred (3.7% stroke rate for 108 patients; 3.5% in 114 procedures), all in symptomatic patients, one of whom died. There were 5 (4.4%) transient ischemic attacks and 2 (1.8%) brief seizure episodes during dilation. One patient died of a cardiac event on day 20. The all stroke or death rate was 5.3% based on 114 arteries at risk (5.6% in 108 patients). In the mean 6-month follow-up (range 1 to 36) of 97 eligible patients, 3 (3.1%) died from unrelated causes. There was 1 restenosis (1.0%) from a stent compression, which was successfully redilated. There were no neurological sequelae, cranial palsies, or cases of stent or vessel thrombosis in follow-up.
Conclusions:
The use of stents in the treatment of cervical carotid occlusive disease appears feasible, effective in the short term, and without excessive risk of periprocedural stroke.