Angioplasty and stent placement in symptomatic internal carotid occlusion.
OBJECTIVE
To report a series of patients with symptomatic internal carotid artery (ICA) occlusion treated with angioplasty and stents.


METHODS
From a consecutive series of 50 patients experiencing neurologic ischemic symptoms and shown by conventional ultrasonography (US) to have a total ICA occlusion, 16 patients (ages 45-79 years; mean, 63 y; 10 men) were selected between August 2006 to September 2008 to be treated with angioplasty based on discovery of an open ICA distal to the occlusion through contrast-enhanced echo Doppler imaging and/or multislice contrast computed tomography (CT). Angioplasty and stent placement were performed under cerebral protection. Follow-up duplex imaging was performed at 14 days and 3 months and every 6 months thereafter and CT follow-up was performed at 2-9 months; the mean follow-up period was 9.9 months.


RESULTS
Lesion crossing and stent placement was successful in 13 of 16 patients. There were no deaths, conversions, cardiac complications, or major strokes. One patient had a transient mild hemiparesis in the upper limb, with total recovery in 3 months. At follow-up, all 13 patients with a good initial result remained with patent arterial lumens and resolution of neurologic ischemic symptoms. After 2-9 months, ICAs with a "string sign" had calibers close or equal to those of normal arteries.


CONCLUSIONS
Angioplasty with stent placement is an effective treatment with a low morbidity rate for selected patients who continue to experience neurologic ischemic symptoms despite US findings of total occlusion of the ICA.
Puech-Leão
Pedro
P
Department of Vascular and Endovascular Surgery, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. drpuech@usp.br
Neves
Celso Ricardo Bregalda
CR
da Silva
Erasmo Simão
ES
Ventura
Carlos
C
Tachibana
Adriano
A
Cevasco
Flávia K
FK
D000368:Aged; D000800:Angioplasty, Balloon; D001807:Blood Vessel Prosthesis; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography