Balloon Angioplasty and Stenting for Carotid Artery Stenosis in an Elderly Patient : A Case Report

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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Comparison of angioplasty and stenting with cerebral protection versus endarterectomy for treatment of internal carotid artery stenosis in elderly patients

Journal of Vascular Surgery ◽

10.1016/j.jvs.2004.08.022 ◽

2004 ◽

Vol 40 (5) ◽

pp. 945-951 ◽

Cited By ~ 59

Author(s):

Andreas Kastrup ◽

J.örg B. Schulz ◽

Sabine Raygrotzki ◽

Klaus Gröschel ◽

Ulrike Ernemann

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Elderly Patients ◽

Carotid Artery Stenosis ◽

Internal Carotid ◽

Internal Carotid Artery Stenosis ◽

Artery Stenosis ◽

Cerebral Protection ◽

Angioplasty And Stenting

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Angioplasty and stenting for carotid artery stenosis: indications, techniques, results, and complications

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.6.6 ◽

1998 ◽

Vol 5 (6) ◽

pp. E5 ◽

Cited By ~ 1

Author(s):

Giuseppe Lanzino ◽

Richard D. Fessler ◽

Robert A. Mericle ◽

Ajay K. Wakhloo ◽

Lee R. Guterman ◽

...

Keyword(s):

High Risk ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Artery Disease ◽

Artery Stenosis ◽

High Risk Patients ◽

Clinical Series ◽

Risk Patients ◽

Artery Disease ◽

Angioplasty And Stenting

Following the favorable results obtained in the treatment of coronary artery disease, combined angioplasty and stenting has been advocated for the treatment of carotid artery stenosis as well. Although widespread application of angioplasty and stenting for carotid artery disease is neither indicated nor recommended, it may be a viable alternative therapy for select patients who are high-risk patients for surgery. The results of early series have suggested that endoluminal revascularization in these high-risk patients can be performed with an acceptable degree of safety. Although the incidence of death and major stroke rates following angioplasty and stenting procedures compares favorably with surgery, results of more recent clinical series have suggested that the incidence of perioperative transient neurological events and minor strokes may be higher than suggested by earlier reports, especially in patients with recent neurological symptoms and “unstable” plaques. In this article, the authors review the current potential indications for and preliminary results of angioplasty and stenting and describe their procedural technique. In addition, potential applications of stenting to intracranial thromboocclusive carotid artery disease are reviewed.

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Periprocedural Thromboembolic Events Associated with Angioplasty and Stenting of the Extra- and Intracranial Carotid Artery Assessed by Neurological Status and Diffusion-Weighted Magnetic Resonance Imaging (DWI)

ISRN Vascular Medicine ◽

10.5402/2012/984178 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7

Author(s):

Frank Ahlhelm ◽

Johanna Lieb ◽

Stefan Ulmer ◽

Dirk Ahlhelm ◽

Wolfgang Reith

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Vessel Diameter ◽

Internal Carotid Artery Stenosis ◽

Artery Stenosis ◽

Thromboembolic Events ◽

Intracranial Stenting ◽

Symptomatic Carotid ◽

Diffusion Weighted ◽

Angioplasty And Stenting

Objective. The purpose of this study was to determine the frequency of thromboembolic events associated with angioplasty and stenting of the carotid artery with special regard to extra- or intracranial localization of stenosis. Methods. Twenty patients with symptomatic intracranial or extracranial internal carotid artery stenosis were treated with stenting and/or angioplasty. In 4 patients stenting was technically not feasible (all in the group with intracranial stenosis). All patients underwent diffusion-weighted imaging (DWI) and neurological examination within 48 hours before and after the procedure to detect periprocedural thrombembolic events. Results. Extracranial carotid angioplasty and stenting (eCAS) was technically feasible and successfull without procedure-related neurological complications in all cases. Intracranial stenting (iCAS) was not feasible in four cases including one patient with a fateful course. Concerning the restoration of the vessel diameter intracranial stenting was not as successful as eCAS, but more effective than balloon angioplasty alone. Incidence of thrombembolic events assessed by DWI was low. The detected periprocedural thrombembolic events were small and clinically silent. Conclusion. The risk of thromboembolic events during the endovascular treatment of symptomatic carotid artery stenosis was rather low for intra- and extracranial stenosis of the ICA in our patient sample, but one fatal course was observed.

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