Stenting in the Carotid Artery: Initial Experience in 110 Patients

J Endovasc Surg. 1996 Feb;3(1):42-62. doi: 10.1583/1074-6218(1996)003<0042:SITCAI>2.0.CO;2.

Abstract

Purpose: To evaluate the feasibility, safety, and efficacy of intravascular stents in the treatment of extracranial carotid artery occlusive disease.

Methods: According to protocol, stent therapy was offered to symptomatic patients with > or = 70% arteriographically defined carotid stenoses or ulcerative lesions and, after September 1994, to asymptomatic patients with > or = 75% stenoses. From April 1993 to September 1995, 110 nonconsecutive patients (79 males; mean age 72 years, range 45 to 85) consented to participate in the study. The majority (79 [72%]) were asymptomatic. Lesions meeting the treatment criteria were in the proximal common (n = 3); mid common (n = 12); distal common (n = 8); internal (ICA) (n = 92); and external (n = 2) carotid arteries. Seven patients had bilateral ICA stenoses, and 17 patients were treated for postsurgical recurrent disease. The mean lesion length and diameter stenosis for all lesions were 12.4 +/- 9.2 mm and 86.5% +/- 10.6%, respectively. The procedures were performed either via direct percutaneous access to the cervical common carotid artery or through a retrograde femoral artery approach. Standard balloon dilation preceded deployment of balloon-expandable stents in most cases. No postprocedural anticoagulation was used (aspirin only).

Results: In 110 patients (117 arteries) intended for treatment, 109 (99.0%) (116 arteries [99.1%]) were successfully treated with 129 stents (128 Palmaz, 1 Wallstent). One percutaneous procedure failed (0.9%) for technical reasons (stent could not be deployed) and was converted to carotid endarterectomy. Minor complications included 4 cases of spasm (successfully treated with papaverine); 1 flow-limiting dissection (stented); and 6 access-site problems. There were 7 strokes (2 major, 5 reversible) (6.4%) and 5 minor transient events (4.5%) that resolved within 24 hours. Three patients were converted to endarterectomy (2.7%) prior to discharge; 1 stroke patient expired (0.9%), and another patient died of an unrelated cardiac event in hospital. In the 30-day postprocedural period, 2 ICA stents occluded (patients asymptomatic). Clinical success at 30 days (no technical failure, death, endarterectomy, stroke, or occlusion) was 89.1% (98/110). Over a mean 7.6-month follow-up (range 2 to 31), no new neurological symptoms developed. Another stent occlusion at 2 months and one case of flow-limiting intimal hyperplasia at 7 months were detected on routine duplex scanning in asymptomatic patients. Life-table analysis shows an 89% cumulative primary patency rate.

Conclusions: Based on this early experience, carotid stenting appears feasible from a technical standpoint, with good midterm patency. However, the incidence of neurological sequelae is a serious problem. Technical enhancements and a more aggressive antiplatelet regimen may have a positive impact on these events.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon* / instrumentation
  • Angioplasty, Balloon* / methods
  • Arterial Occlusive Diseases / pathology
  • Arterial Occlusive Diseases / surgery
  • Arterial Occlusive Diseases / therapy*
  • Aspirin / therapeutic use
  • Carotid Artery Diseases / pathology
  • Carotid Artery Diseases / surgery
  • Carotid Artery Diseases / therapy*
  • Carotid Artery, Common
  • Carotid Artery, External
  • Carotid Artery, Internal
  • Carotid Stenosis / pathology
  • Carotid Stenosis / surgery
  • Carotid Stenosis / therapy
  • Cerebrovascular Disorders / etiology
  • Endarterectomy, Carotid
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Ischemic Attack, Transient / etiology
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use
  • Recurrence
  • Safety
  • Stents*
  • Survival Rate
  • Treatment Outcome
  • Ulcer
  • Vascular Patency
  • Vasoconstriction

Substances

  • Platelet Aggregation Inhibitors
  • Aspirin