Carotid artery stenting in patients at surgical high risk: clinical and ultrasound findings

• Published in: Cerebrovascular diseases (Basel, Switzerland) Vol. 10; no. 1; p. 44
• Main Authors: Griewing, B, Brassel, F, von Smekal, U, Al Ahmar, M T, Kessler, C
• Format: Journal Article
• Language: English
• Published: Switzerland 01-01-2000
• Subjects: Aged; Aged, 80 and over; Angioplasty; Anticoagulants - therapeutic use; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - surgery; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; Cerebral Angiography; Endarterectomy, Carotid; Female; Heparin - therapeutic use; Humans; Male; Middle Aged; Risk Factors; Stents; Ultrasonography
• ISSN: 1015-9770
• DOI: 10.1159/000016024

Angioplasty and stenting (A/S) provide an alternative for patients with simultaneous severe cardiac and cerebrovascular disease, or with medical illnesses which carry a high perioperative risk. We conducted A/S in 20 high-risk patients (15 males, 5 females, mean age = 64.5 years, range = 49-83 years) with symptomatic (n = 16) and asymptomatic (n = 4) high-grade stenosis (>70%, NASCET criterion) of the internal carotid artery. Patients had neurological examinations before, during and after the procedure. Color-coded duplex sonography was performed before and 24 h and every 3 months after the procedure; the 3-month examination also included cerebral angiography. The mean degree of stenosis was reduced from 85.75 +/- 7.47 to 8.0 +/- 22.09% in angiography. In an 18-month follow-up with color-coded duplex sonography the effects of the A/S could be visualized effectively: 2 with local, transient vasospasms, 1 with asymptomatic occlusion, 2 carotid arteries with remaining stenosis of 50% and 2 with minimal hyperplasia within the stent. In conclusion, in patients with a high perioperative risk, A/S is a therapeutic alternative to surgery.