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(Stroke. 2003;34:e42.)
© 2003 American Heart Association, Inc.

Letters to the Editor

Carotid Angioplasty With Stenting and Carotid Endarterectomy for High-Risk Patients

Section of Vascular Surgery, University of Genova, Genova, Italy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

I have read with interest the article by Fox et al¹ with regard to carotid angioplasty and stenting. I feel that the article might be a further contribution toward evaluating this procedure. Despite the limited experience on 42 cases of symptomatic carotid stenosis, the article is important particularly because it shows the long-term results of carotid angioplasty and stenting, and the effectiveness of the procedure as compared with conservative treatment.

Moreover, the article suggests some other concerns about carotid angioplasty.

The technique involves some issues that need to be debated at the present time: indications, cerebral protection, immediate and long-term results.

I would like to focus on indications for the technique. With regard to this point, the study by Fox et al¹ suggests using carotid angioplasty on poor surgical candidates, including those with concomitant morbidities, restenosis, stenosis after cervical irradiation, and anatomic characteristics of the carotid stenosis.

From this point of view, carotid angioplasty is an alternative to carotid endarterectomy, and the two should be compared. In comparing these procedures, we have to take into account the current results of carotid endarterectomy. I agree with Fox et al¹ regarding a preference for carotid angioplasty in postirradiation stenosis, restenosis, and anatomic characteristics (stenosis involving distal extracranial internal carotid artery, etc). With regard to the subgroup of patients with comorbidities, I feel that some caution is needed when considering carotid angioplasty. In the report by Fox et al,¹ carotid angioplasty was followed by important complications in 4/42 (9.5%) cases. . . . [Full Text of this Article]

D.L. Fox, MD; C.P. Derdeyn, MD; C.J. Moran, MD; D.T. Cross, III, MD; R.L. Grubb, Jr, MD R.G. Dacey, Jr, MD

Interventional Neuroradiology, Mallinckrodt Institute of Radiology and the Department of Neurology and Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri