Carotid artery stenosis: Treatment with protected balloon angioplasty and stent placement

PURPOSE: To assess effectiveness of endovascular treatment of carotid artery stenosis by means of angioplasty with cerebral protection and stent placement. MATERIALS AND METHODS: Angioplasty was performed for carotid artery stenosis in 259 patients. Cerebral protection (triple coaxial catheter) was used in 136 cases of atherosclerotic stenosis in the internal carotid artery or in the carotid bifurcation and was not used in 123 cases. A stent was placed in 69 patients when images obtained immediately after angioplasty showed signs of dissection or insufficient arterial opening. RESULTS: No procedure-related complications occurred in the 71 cases of nonatherosclerotic stenosis and in the 14 cases of proximal carotid artery and siphon atherosclerotic stenosis. Among the 38 patients who underwent angioplasty without cerebral protection, dissection occurred in two (5%) and embolic complication occurred in three (8%) during the procedure. Among 136 patients in whom cerebral protection was used, no embolic complications occurred during angioplasty, and two (1%) occurred during or after stent placement without protection. No residual flaps were found after stents were placed, and the restenosis rate decreased from 16% to 4%. CONCLUSION: Endovascular treatment can be considered for all types of carotid artery stenosis. Cerebral protection is mandatory to eliminate embolic complication in cases of atherosclerotic stenosis in the internal carotid artery or carotid bifurcation. Stent placement has eliminated the risk of immediate dissection and reduced the risk of delayed restenosis.