Delayed improvement in carotid artery diameter after carotid angioplasty.
OBJECTIVE
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 > or = 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 > or = 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%.
Crawley
F
F
Division of Clinical Neuroscience, St George's Hospital Medical School, UK.
Clifton
A
A
Markus
H
H
Brown
M M
MM
D000368:Aged; D015901:Angiography, Digital Subtraction; D017130:Angioplasty / Q000706:statistics & numerical data*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015607:Stents; D014463:Ultrasonography