Angioplasty and stenting of the extracranial carotid arteries

J Endovasc Surg. 1998 Nov;5(4):293-304. doi: 10.1583/1074-6218(1998)005<0293:AASOTE>2.0.CO;2.


Purpose: To study the feasibility and safety of stent-supported angioplasty in the treatment of atherosclerotic stenoses of the extracranial carotid arteries.

Methods: Carotid angioplasty was attempted in 174 arteries (163 patients: 126 males; mean age: 71 +/- 10 years, range 47 to 93). Mean lesion length was 15.1 +/- 4.1 mm, and mean percent stenosis was 83.8% +/- 7.3% (reference diameter 5.8 +/- 0.7 mm). The majority (106, 65%) were asymptomatic (51% of all patients had severe coronary disease, 32% had peripheral vascular diseases). Patients underwent independent neurological examination, computed tomography, duplex ultrasonography, and angiography preprocedurally, 24 hours after the procedure, and at 6-month follow-up intervals. Most (142, 82%) carotid arteries were treated without cerebral protection, but a protective triple coaxial catheter was used in 32 (18%) patients. Stents (primarily Palmaz and Wallstent) were deployed routinely in all cases; 18% were implanted without predilation.

Results: Immediate technical success was 173 of 174 (99.4%) (1 access failure referred electively to surgery). Eight (4.6%) neurological complications occurred in the periprocedural period: 3 transient ischemic attacks, 2 minor strokes, and 3 major strokes (1 amaurosis and 2 hemiplegias). Two major complications developed despite cerebral protection. There were no deaths or myocardial infarctions and only 3 cervical access site hematomas. Over a mean 12.7 +/- 9.2 month follow-up (range 1 to 36), no ipsilateral neurological complications have been seen. There were 4 (2.3%) restenoses (3 redilated, 1 treated medically) and 1 mild Palmaz stent compression, all found within the first 6 months. Primary and secondary patencies at 3 years are 96% and 99%, respectively.

Conclusions: Angioplasty with routine stenting seems feasible and safe for treating certain types of carotid stenoses even in high-surgical risk patients; however, randomized trials are necessary before this treatment can be offered as an alternative to endarterectomy.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon*
  • Arteriosclerosis / therapy*
  • Carotid Stenosis / therapy*
  • Electroencephalography
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurologic Examination
  • Stents*
  • Treatment Outcome
  • Vascular Patency