Interventional treatment of carotid artery stenosis

Background and objective: The therapeutic efficacy of carotid thrombendarterectomy (TEA) for high-grade symptomatic or asymptomatic carotid stenosis is considered as proven. But in many centres percutaneous transluminal angioplasty (PTA) has become an ever more frequent alternative to operation. This report concerns 34 cases of carotid PTA, most of them in conjunction with stent implantation. Patients and methods: Between September 1994 and December 1996, a total of 34 percutaneous transfemoral angioplasties (similar technique to coronary angioplasty) for carotid stenosis was performed in 30 patients (six women, 24 men; mean age 66 +/- 11 years). PTA alone was undertaken in the first eight interventions, PTA together with primary stent implantation in the remaining 26. Results: With one exception (PTA only) all interventions (including stent implantation) were successful with good primary angiographic results. The dilatation decreased the luminal stenosis from a mean of 83.4% (+/- 9.9%) of vessel diameter to 13.0 (+/- 12.4%). Complications were a stent occlusion with prolongated ischaemic neurological deficit, completely reversed within 2 days, in one patient and transitory ischaemic attacks in two others. Conclusion: Experience to-date indicates that PTA with stent implantation in the carotid artery is a satisfactory alternative to carotid TEA, especially in patients with an increased operative risk.