(Stroke. 2000;31:3029.)
© 2000 American Heart Association, Inc.
Original Contributions |
Stent Angioplasty for Cervical Carotid Artery Stenosis in High-Risk Symptomatic NASCET-Ineligible Patients
From the Departments of Radiology, Division of Interventional Neurovascular Radiology (A.M.M., R.T.H., C.C.P., T.E.L., P.M.M., C.F.D., V.V.H.), Neurology (W.S.S.), and Neurosurgery (R.T.H., C.F.D., V.V.H.), University of California at San Francisco.
Correspondence to Adel M. Malek, MD, PhD, Department of Neurosurgery, Brigham & Women’s and Children’s Hospitals, Bader 3, 300 Longwood Ave, Boston, MA 02115. E-mail amalek{at}partners.org
Background and Purpose—Although the North American Symptomatic Carotid Endarterectomy Trial (NASCET) has shown carotid endarterectomy (CEA) to be protective compared with medical therapy alone, its stringent eligibility criteria excluded patients with severe medical, angiographic, and neurological risk factors. We sought to determine the safety and efficacy of stent angioplasty in this high-risk subset for whom the perioperative morbidity and mortality of surgery are elevated.
Methods—Twenty-eight consecutive symptomatic NASCET-ineligible patients (10 female; median age, 72.2 years) underwent microcatheter-based carotid stent angioplasty. Half of the patients had sustained a previous stroke. Classification of surgical risk by Sundt criteria yielded no patients in grade 1, 3 patients in grade 2 (10.7%), 8 in grade 3 (28.6%), and 17 (60.7%) in grade 4. Stratification of stroke risk for medical therapy according to the European Carotid Surgery Trial (ECST) 5-point score showed 8 patients with a score of 3 (28.6%), 12 with 4 (42.8%), and 8 with 5 (28.6%). Follow-up was obtained in all patients at a median of 14 months.
Results—The procedure was technically successful in all cases (100%), with immediate stenosis reduction from a mean of 80.3% to 2.7%. There were no periprocedural deaths, 1 major stroke (3.6%), no minor strokes, and 3 transient ischemic attacks (10.7%). In-hospital complications included 2 nonfatal myocardial infarctions, 1 case of acute renal failure, and 1 groin hematoma requiring transfusion. There were 5 deaths during the follow-up period, all beyond 30 days after the procedure: 3 from cardiac causes, 1 from lung cancer, and 1 following unrelated surgery. The patient with major stroke died at 7.8 months during rehabilitation. No surviving patients had further strokes, and all except 1 (95.5%) remained asymptomatic. Anatomic follow-up in 20 patients showed occlusion in 2 (10%) (1 symptomatic, 1 asymptomatic) and intimal hyperplasia in 3 asymptomatic patients (15%).
Conclusions—The clinical results and sustained freedom from symptoms and stroke during the short available follow-up period suggest that stent angioplasty may be useful in the treatment of symptomatic cervical carotid stenosis in high-risk patients despite a notable incidence of restenosis.
Key Words: angioplasty • carotid endarterectomy • carotid stenosis • endovascular therapy • stents
This article has been cited by other articles:
 |
|
 |
|
  K. Groschel, U. Ernemann, J. B. Schulz, T. Nagele, C. Terborg, and A. Kastrup Statin Therapy at Carotid Angioplasty and Stent Placement: Effect on Procedure-related Stroke, Myocardial Infarction, and Death. Radiology, July 1, 2006; 240(1): 145 - 151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. B. Orbach, B. K. Pramanik, J. Lee, T. S. Maldonado, T. Riles, and R. I. Grossman Carotid Artery Stent Implantation: Evaluation with Multi-Detector Row CT Angiography and Virtual Angioscopy--Initial Experience Radiology, January 1, 2006; 238(1): 309 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. G. Roh, H. S. Byun, J. W. Ryoo, D. G. Na, W.-J. Moon, B. B. Lee, and D.-I. Kim Prospective Analysis of Cerebral Infarction After Carotid Endarterectomy and Carotid Artery Stent Placement by Using Diffusion-Weighted Imaging AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 376 - 384. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Kaku, S.-i. Yoshimura, and J. Kokuzawa Factors Predictive of Cerebral Hyperperfusion after Carotid Angioplasty and Stent Placement AJNR Am. J. Neuroradiol., September 1, 2004; 25(8): 1403 - 1408. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. T. Higashida, P. M. Meyers, C. C. Phatouros, J. J. Connors III, J. D. Barr, D. Sacks, and for the Technology Assessment Committees of the Am Reporting Standards for Carotid Artery Angioplasty and Stent Placement Stroke, May 1, 2004; 35(5): e112 - e134. [Full Text] [PDF]
|
|
|
|
 |
|
 I. Linfante, J. A. Hirsch, M. Selim, G. Schlaug, L. R. Caplan, and A. S. Reddy Safety of Latest-Generation Self-expanding Stents in Patients With NASCET-Ineligible Severe Symptomatic Extracranial Internal Carotid Artery Stenosis Arch Neurol, January 1, 2004; 61(1): 39 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Barr, J. J. Connors III, D. Sacks, J. C. Wojak, G. J. Becker, J. F. Cardella, B. Chopko, J. E. Dion, A. J. Fox, R. T. Higashida, et al. Quality Improvement Guidelines for the Performance of Cervical Carotid Angioplasty and Stent Placement: Developed by a Collaborative Panel of the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, and the Society of Interventional Radiology AJNR Am. J. Neuroradiol., November 1, 2003; 24(10): 2020 - 2034. [Full Text] [PDF]
|
|
|
|
|
|
K. Yoshida, K. Nozaki, K.-i. Kikuta, A. Sadato, S. Miyamoto, and N. Hashimoto Contrast-Enhanced Carotid Color-Coded Duplex Sonography for Carotid Stenting Follow-Up Assessment AJNR Am. J. Neuroradiol., May 1, 2003; 24(5): 992 - 995. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Ballotta, G. D. Giau, C. Baracchini, C. P. Derdeyn, D. Fox, C. J. Moran, D. T. Cross III, and R. G. Dacey Jr Carotid Angioplasty and Stenting in High-Risk Patients With Severe Symptomatic Carotid Stenosis Stroke, April 1, 2003; 34(4): 834 - 835. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Taylor, F. Alcocer, and W. D. Jordan Jr Controversies in Carotid Stenting Vascular and Endovascular Surgery, March 1, 2003; 37(2): 79 - 87. [Abstract] [PDF]
|
|
|
|
|
|
A. Kastrup, K. Groschel, H. Krapf, B. R. Brehm, J. Dichgans, and J. B. Schulz Early Outcome of Carotid Angioplasty and Stenting With and Without Cerebral Protection Devices: A Systematic Review of the Literature Stroke, March 1, 2003; 34(3): 813 - 819. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Fox Jr, C. J. Moran, D. T. Cross III, R. L. Grubb Jr, K. M. Rich, M. R. Chicoine, R. G. Dacey Jr, and C. P. Derdeyn Long-Term Outcome After Angioplasty for Symptomatic Extracranial Carotid Stenosis in Poor Surgical Candidates Stroke, December 1, 2002; 33(12): 2877 - 2880. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E.J. Cunningham, R. Bond, Z. Mehta, M.R. Mayberg, C.P. Warlow, and P.M. Rothwell Long-Term Durability of Carotid Endarterectomy for Symptomatic Stenosis and Risk Factors for Late Postoperative Stroke Stroke, November 1, 2002; 33(11): 2658 - 2663. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. M. van Heesewijk, J. A. Vos, E. S. Louwerse, J. C. van den Berg, T. T. C. Overtoom, S. M. P. G. Ernst, H. W. Mauser, F. L. Moll, and R. G. A. Ackerstaff New Brain Lesions at MR Imaging after Carotid Angioplasty and Stent Placement Radiology, August 1, 2002; 224(2): 361 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. G. Nadareishvili, B. Bowyer, G. Cheung, D. W. Rowed, R. Maggisano, and J. W. Norris How Safe Is Carotid Angioplasty and Stenting in NASCET-Ineligible Patients? Stroke, November 1, 2001; 32(11): 2726 - 2726. [Full Text] [PDF]
|
|