Results of Balloon Angioplasty in the Carotid Arteries

Purpose: To report the experiences to date with percutaneous transluminal angioplasty (PTA) of the carotid artery and other supra-aortic vessels. A new coaxial dilatation system for carotid angioplasty with temporary balloon occlusion to avoid cerebral embolization is presented. Methods: PTA was performed in 220 patients with 245 stenosed or occluded supra-aortic arteries; among these were 74 carotid stenoses in the proximal common (n = 5), distal common (n = 1), internal (n = 65), and external (n = 3) carotid arteries. Duplex and B-mode ultrasonography, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, indium 111-labeled platelet scintigraphy, and/or angiography were used before and after PTA. Intravascular ultrasound imaging was also recently added for monitoring angioplasty results. Results: All patients but one with carotid lesions had symptoms of cerebrovascular insufficiency. Angioplasty was successful in 69 of the 74 carotid stenoses: proximal common (n = 5), distal common (n = 1), internal (n = 60), and external (n = 3). There were only 1 major (hemiparesis) and 2 minor complications. During the average 70-month observation period, restenosis has not occurred in any treated carotid artery. In a literature review of > 500 patients undergoing carotid angioplasty, the complication rate appears very low (mortality 0%; morbidity 2.1%) and comparable to that for carotid endarterectomy. Conclusions: Results of this review suggest that percutaneous transluminal angioplasty of the carotid artery is an effective alternative method to vascular surgery, particularly for patients with comorbidities that elevate the risks of surgery.

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Failure of Transluminal Angioplasty in the Treatment of Myointimal Hyperplasia of the Internal Carotid Artery: Case Report

Neurosurgery ◽

10.1227/00006123-199101000-00021 ◽

1991 ◽

Vol 28 (1) ◽

pp. 148-151 ◽

Cited By ~ 4

Author(s):

Frank Culicchia ◽

Robert F. Spetzler ◽

Richard A. Flom

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Percutaneous Transluminal Angioplasty ◽

Carotid Arteries ◽

Internal Carotid ◽

Transluminal Angioplasty ◽

Angiographic Study ◽

Vessel Lumen ◽

Percutaneous Transluminal

Abstract Recurrent stenosis of the carotid arteries after a carotid endarterectomy for atherosclerosis can occur as a result of myointimal hyperplasia. This condition was treated by percutaneous transluminal angioplasty. Excellent dilatation of the vessel lumen was documented after balloon dilatation. A 6-month follow-up angiographic study, however, demonstrated recurrent high-grade stenosis at the same level in both carotid arteries. Presumably, the failure of percutaneous transluminal angioplasty and the treatment of myointimal hyperplasia of the internal carotid artery results in the same condition after the original endarterectomy, that is, additional myointimal hyperplasia.

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Percutaneous transluminal carotid angioplasty in fibromuscular dysplasia

Journal of Neurosurgery ◽

10.3171/jns.1983.59.1.0162 ◽

1983 ◽

Vol 59 (1) ◽

pp. 162-165 ◽

Cited By ~ 16

Author(s):

Arthur B. Dublin ◽

Harold A. Baltaxe ◽

Cully A. Cobb

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Percutaneous Transluminal Angioplasty ◽

Fibromuscular Dysplasia ◽

Internal Carotid ◽

Transluminal Angioplasty ◽

Carotid Angioplasty ◽

Content Type ◽

Percutaneous Transluminal ◽

Fine Print

✓ A patient with fibromuscular dysplasia (FMD) of the internal carotid artery was treated by balloon percutaneous transluminal angioplasty (PTA). This is the sixth reported case of FMD stenotic disease which was dilated by PTA. All previous cases including the current example were treated successfully with resolution of symptoms. This procedure is associated with a relatively low morbidity and is an alternative method of treatment to operative endarterectomy for this disorder.

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Symptomatic Middle Cerebral Artery Stenosis Treated by Percutaneous Transluminal Angioplasty: Improvement of Cerebrovascular Reserves

Interventional Neuroradiology ◽

10.1177/159101991201800215 ◽

2012 ◽

Vol 18 (2) ◽

pp. 213-220 ◽

Cited By ~ 6

Author(s):

A. Abe ◽

T. Ueda ◽

M. Ueda ◽

S. Nogoshi ◽

Y. Nishiyama ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Percutaneous Transluminal Angioplasty ◽

Single Photon ◽

Photon Emission ◽

Transluminal Angioplasty ◽

Emission Computed Tomography ◽

Blood Flows ◽

Percutaneous Transluminal ◽

Photon Emission Computed Tomography

This study evaluated the recoveries of cerebrovascular reserves (CVR) after applying percutaneous transluminal angioplasty (PTA) to patients with symptomatic middle cerebral artery (MCA) stenosis of varying severity. The patients were submitted to single photon emission computed tomography (SPECT) to obtain their regional cerebral blood flows at resting stage (rCBFrest) and acetazolamide-challenged CBF in five regions of interest (ROIs), including the MCA, on the ipsilateral and contralateral sides of the hemisphere. rCVR values were then calculated from these CBF data to evaluate the CVR recoveries after PTA treatment. When the PTA effects were statistically analyzed of the patients dichotomized into more severe (n=9) and less severe (n=5) groups, distinctly significant ROI-specific PTA effectiveness was observed for CVR rather than CBF values in the patients of the severer group.

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Percutaneous transluminal angioplasty and stenting for recurrent carotid artery stenosis

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.6.8 ◽

1998 ◽

Vol 5 (6) ◽

pp. E7

Author(s):

Giuseppe Lanzino ◽

Robert A. Mericle ◽

Demetrius K. Lopes ◽

Ajay K. Wakhloo ◽

Lee R. Guterman ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Artery Stenosis ◽

Cardiac Complications ◽

Neurological Event ◽

Angioplasty And Stenting ◽

Percutaneous Transluminal

Percutaneous transluminal angioplasty (PTA) and stenting has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stenting for carotid artery restenosis. The mean interval between endarterectomy and the endovascular procedure was 57 months (range 8-220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stenting in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event. A pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6-57 months). Three of five patients who underwent PTA alone developed significant (> 50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stenting in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty with stenting. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.

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