Carotid artery stenting in patients at surgical high risk: clinical and ultrasound findings.
Angioplasty and stenting (A/S) provide an alternative for patients with simultaneous severe cardiac and cerebrovascular disease, or with medical illnesses which carry a high perioperative risk. We conducted A/S in 20 high-risk patients (15 males, 5 females, mean age = 64.5 years, range = 49-83 years) with symptomatic (n = 16) and asymptomatic (n = 4) high-grade stenosis (>70%, NASCET criterion) of the internal carotid artery. Patients had neurological examinations before, during and after the procedure. Color-coded duplex sonography was performed before and 24 h and every 3 months after the procedure; the 3-month examination also included cerebral angiography. The mean degree of stenosis was reduced from 85.75 +/- 7.47 to 8.0 +/- 22.09% in angiography. In an 18-month follow-up with color-coded duplex sonography the effects of the A/S could be visualized effectively: 2 with local, transient vasospasms, 1 with asymptomatic occlusion, 2 carotid arteries with remaining stenosis of 50% and 2 with minimal hyperplasia within the stent. In conclusion, in patients with a high perioperative risk, A/S is a therapeutic alternative to surgery.
Griewing
B
B
Department of Neurology and Neuroradiology, Rhön-Klinikum, Bad Neustadt, Germany. castroke@neurologie-bad-neustadt.de
Brassel
F
F
von Smekal
U
U
Al Ahmar
M T
MT
Kessler
C
C
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D000925:Anticoagulants / Q000627:therapeutic use; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D002533:Cerebral Angiography; D016894:Endarterectomy, Carotid; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents; D014463:Ultrasonography
D000925:Anticoagulants; D006493:Heparin