Endovascular therapy of high-degree stenoses of the neck vessels-stent-supported percutaneous angioplasty of the carotid artery without cerebral protection

Purpose: Technical essentials and therapeutic results of carotid stenting without cerebral protection are presented. Materials and Methods: In 161 patients, 167 high grade carotid stenoses were stented, followed by percutaneous transluminal angioplasty, with subsequent evaluation of the clinical and angiographic results. Diffusion-weighted MRI was carried out in 108 patients to detect cerebral sequelae. Results: Endovascular therapy was successful (residual stenosis < 25%) in 166 stenoses (99.4%). Twelve patients (7.5%) had cerebrovascular complications within the 30-day perioperative period, seven of which occurred during the procedure. After treatment, diffusion-weighted MRI disclosed at least one new cerebral lesion in 40 patients (37%), which were symptomatic in six patients. Conclusion: Even without cerebral protection, high grade carotid stenosis can be safely treated with stent-protected percutaneous angioplasty. Micro-emboli detected by postoperative MRI are infrequently symptomatic.