[Stenoses and occlusions of the supraaortic vessels--the interdisciplinary interventional treatment of patients with an increased surgical risk].
OBJECTIVE
The value of elective PTA in stenoses of the supraaortic vessels and especially of the carotid artery is still under discussion. Stenoses after surgical and/or radiation therapy and a high cardio-vascular risk for a surgical procedure, however, justify minimal-invasive techniques.


METHODS
In 31 patients with 24 symptomatic and 7 asymptomatic stenoses of the supraaortic arteries (3 Acc, 19 Aci, 5 Ascl, 4 Tr.brc, 2 Aax) minimal-invasive angioplasty and stent-placement was performed. The rationale for the interventional procedure was an elevated medical or technical risk of the respective surgical procedure. All procedures were performed using a coaxial technique with a guiding catheter. An open vascular access was necessary in 7 cases due to an unfavorable anatomical situation.


RESULTS
The technical success rate was 100%. Peri-interventionally, a TIA occurred in 2 patients (1 spontaneous relieve, 1 complete remission after rt-PA lysis therapy). During the mean follow-up period of 13 months 3 patients died due to non-cerebrovascular reasons. In 2 patients a moderate restenosis, in 1 a high-grade stenosis, and in 1 and complete occlusion occurred without symptoms. After one year of follow-up, all treated stenoses were patent with a restenosis rate of 10.7% without further neurological symptoms.


CONCLUSIONS
Interventional angioplasty with stent-placement of the supraaortic arteries is a safe and effective alternative in patients are at high risk for classical surgical procedures.
Helmberger
T
T
Institut für Klinische Radiologie, Klinikum der Universität, Grosshadern, München. Helmberg@ikra.med.uni-muenchen.de
Heiss
M
M
Bayer
B
B
Billing
A
A
Holzknecht
N
N
Reiser
M
M
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D015641:Radiography, Interventional; D012307:Risk Factors; D015607:Stents; D014463:Ultrasonography
D005343:Fibrinolytic Agents