[Outpatient primary stent-angioplasty in symptomatic internal carotid artery stenoses].
In 81 patients, average age 69.3 (57-79) years with symptomatic ICA stenosis stent implantation was performed under outpatient conditions. An interdisciplinary consensus ascertained that the patients were suitable for outpatient therapy. In accordance with the NASCET criteria all patients belonged to the high-risk group. Within 120 days before the intervention, the following clinical events had occurred: 32 minor strokes, 43 TIA, 20 amaurosis fugax. 61/81 patients revealed a bulbar, 20/81 a postbulbar ICA stenosis, the average degree of stenosis was 88.6 % (75-97). Stent application, using 3 different stent models, and subsequent PTA were always performed under protection. The transfemoral route was always treated with an endovascular closure system. All patients were given follow-up examinations by means of colour duplex sonography (CDS) of the neck vessels on days 1, 30, 180 and 360, and contrast-medium intensified MRT on day 5 post-intervention. The technical success rate with regard to stenting and PTA was 100 %. One case of hypotonic dysregulation occurred during the intervention. Atheromatous particles and plaque fragments were found in the protection system in 3/81 (3.7%) of the patients. A plaque embolism was excluded clinically and in the contrast-medium intensified MRT 5 days after the intervention in 79/81 (97.5%) of the patients, while two patients were found to sustain an asymptomatic cortical barrier impairment. After 180 days, no restenosis or stent dislocation were found in the CDS, all ECAs were perfused. After 360 days, one asymptomatic occlusion and four restenoses > 70% were found (5/81 = 6.2% restenosis rate after 1 year), which were successfully treated by angioplasty. The method presented bears a low complication rate and shows a high success rate. If patient recruitment is adequate, this intervention can safely be performed on an outpatient basis.
Andresen
R
R
Abteilung für Bildgebende Diagnostik und Interventionelle Radiologie, Güstrower Krankenhaus, Universität Rostock. dreimer.andresen@gmx.de
Roth
M
M
Brinckmann
W
W
D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D004617:Embolism / Q000517:prevention & control; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D019736:Prostheses and Implants; D012307:Risk Factors; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin