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(Stroke. 1997;28:574-579.)
© 1997 American Heart Association, Inc.

Articles

Delayed Improvement in Carotid Artery Diameter After Carotid Angioplasty

Francesca Crawley, MRCP; Andrew Clifton, FRCR; Hugh Markus, MRCP, DM; Martin M. Brown, MD, FRCP

From the Division of Clinical Neuroscience, St George's Hospital Medical School (F.C., M.M.B.); Department of Neuroradiology, Atkinson Morley's Hospital (A.C.); and Department of Neurology, King's College School of Medicine and Dentistry (H.M.), London, UK.

Correspondence to Dr Martin M. Brown, Division of Clinical Neuroscience, St George's Hospital Medical School, Cranmer Terrace, London, SW17 ORE, UK. E-mail mbrown{at}sghms.ac.uk.

Background and Purpose Carotid percutaneous transluminal angioplasty (PTA) is a new method of treating carotid artery stenosis. There has been concern about restenosis after carotid PTA. This study was performed to ascertain the change in percent stenosis 1 year after carotid PTA.

Methods Twelve patients with symptomatic carotid stenosis were treated by PTA, and the anatomic result was studied by digital subtraction angiography at 1 year, supplemented by duplex ultrasound examinations at 1 month and 6 months.

Results The mean severity of stenosis treated, measured by the common carotid method, was 82% (range, 69% to 98%). The immediate result of PTA was a reduction in the severity of stenosis in all patients to a mean of 51% (P<.005). Six of the 12 patients showed a further improvement in lumen diameter of 14% at 1-year angiographic follow-up from a mean stenosis of 47% (range, 24% to 76%) immediately after PTA to 28% (range, 0% to 52%) at 1 year. This indicates an active process of remodeling in response to carotid PTA. PTA initially reduced the stenosis by 20% in 9 of the 12 arteries, and 8 of these remodeled or remained largely unchanged compared with only 1 of the 3 with a suboptimal initial dilation. In 3 patients the lumen diameter improved by <5%. Three other patients restenosed with an increase in stenosis after PTA of 9%, 16%, and 66% at 1 year, but all were asymptomatic. The duplex findings showed that remodeling occurred at variable times between PTA and 1 year.

Conclusions Remodeling of the carotid artery after PTA has not been described before. Our results confirm that carotid angioplasty has an acceptable patency rate at 1 year. It has been suggested that endovascular treatment of carotid stenosis should include placement of a stent. Our results indicate that this may not be necessary unless the initial PTA result is a reduction in stenosis of <20%.

Key Words: angioplasty • carotid stenosis • stents

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