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Endovascular management of internal carotid artery stenosis — evaluation of early results based on own experience
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Abstract
Material and methods: From January 2001 through September 2004, one hundred and thirty-one endovascular procedures involving internal carotid artery angioplasty and stent placement were performed in the Department of General and Vascular Surgery in Katowice. Only one carotid artery dilatation was attempted; in a case of bilateral lesions, angioplasty was performed on the side of the symptomatic, or more severe, stenosis. In 78 procedures (59.5%) neuroprotection was used. The study group involved 92 male and 39 female patients, aged 59 to 84 years (the mean age was 72 years). All patients who elected to undergo endovascular management were considered to be at high surgical risk and had > 70% carotid artery stenosis as determined by an ultrasound examination. The duration of the procedure was 14 to 45 minutes (mean 22 minutes). Hospital stays ranged from 2 to 24 days (mean 2.8 days).
Results: Postoperative ischaemic stroke was observed in 5 patients (3.8%); including 2 procedures with neuroprotection (2.5%), and 3 without neuroprotection (5.6%). Perioperative mortality was 0.76%; a patient died of extensive stroke which occurred during an endovascular procedure without neuroprotection. During the procedure, transient ischaemic attack (TIA) occurred in 6 patients (4.6%), bradycardia in 10 (7.6%) and hypotonia in 12 (9.1%). Bradycardia was sporadic following routine atropin administration prior to stenosis predilation. One patient developed hyperperfusion syndrome with convulsive attacks, headache, and consciousness level deterioration; no cerebral ischaemia was found on the CT. Conversion to open repair proved necessary in one patient.
Conclusion: Angioplasty with stent placement is an effective and safe treatment for a critical carotid artery stenosis.
Abstract
Material and methods: From January 2001 through September 2004, one hundred and thirty-one endovascular procedures involving internal carotid artery angioplasty and stent placement were performed in the Department of General and Vascular Surgery in Katowice. Only one carotid artery dilatation was attempted; in a case of bilateral lesions, angioplasty was performed on the side of the symptomatic, or more severe, stenosis. In 78 procedures (59.5%) neuroprotection was used. The study group involved 92 male and 39 female patients, aged 59 to 84 years (the mean age was 72 years). All patients who elected to undergo endovascular management were considered to be at high surgical risk and had > 70% carotid artery stenosis as determined by an ultrasound examination. The duration of the procedure was 14 to 45 minutes (mean 22 minutes). Hospital stays ranged from 2 to 24 days (mean 2.8 days).
Results: Postoperative ischaemic stroke was observed in 5 patients (3.8%); including 2 procedures with neuroprotection (2.5%), and 3 without neuroprotection (5.6%). Perioperative mortality was 0.76%; a patient died of extensive stroke which occurred during an endovascular procedure without neuroprotection. During the procedure, transient ischaemic attack (TIA) occurred in 6 patients (4.6%), bradycardia in 10 (7.6%) and hypotonia in 12 (9.1%). Bradycardia was sporadic following routine atropin administration prior to stenosis predilation. One patient developed hyperperfusion syndrome with convulsive attacks, headache, and consciousness level deterioration; no cerebral ischaemia was found on the CT. Conversion to open repair proved necessary in one patient.
Conclusion: Angioplasty with stent placement is an effective and safe treatment for a critical carotid artery stenosis.
Keywords
internal carotid artery; stenosis; angioplasty; stent placement; neuroprotection
About this articleTitle
Endovascular management of internal carotid artery stenosis — evaluation of early results based on own experience
Journal
Chirurgia Polska (Polish Surgery)
Issue
Pages
19-26
Published online
2005-05-06
Bibliographic record
Chirurgia Polska 2005;7(1):19-26.
Keywords
internal carotid artery
stenosis
angioplasty
stent placement
neuroprotection
Authors
Wacław Kuczmik
Damian Ziaja
Jacek Kostyra
Arkadiusz Leszczyna
Grzegorz Biolik
Tomasz Ludyga
Tomasz Orawczyk
Teresa Kowalewska-Twardela
Arkadiusz Krupowies
Bartosz Wnuk
Andrzej Ochała
Daria Wziątek-Kuczmik
Krzysztof Ziaja
