title: [Endovascular management of symptomatic carotid stenosis combined with kinking].
abstract: OBJECTIVE
  To study the necessity, feasibility, security of carotid angioplasty and stenting (CAS) for symptomatic carotid stenosis combined with kinking.
  
  
  METHODS
  Twelve patients with symptomatic carotid stenosis and kinking demonstrated by digital subtraction angiography (DSA) received CAS from December 2003 to December 2009. There were 9 male and 3 female patients, age ranged from 59 to 77 years (mean 69.3 years). All the patients' clinical, imaging, intervention and follow up data were collected and analyzed.
  
  
  RESULTS
  All CAS procedures were successfully performed with 14 self-expandable stents placed. The mean degree of stenosis was reduced from 85.6% before stenting to 11.2% after stenting, the angle of kinking, according to Metz' category, were improved from less than 90° to more than 120° in each case. No perioperative procedure related stroke and transient ischemic attack (TIA) occurred. The clinical symptoms and signs of cerebral ischemia were improved or disappeared for all patients. During follow-up of these 12 patients for 6 to 72 months, one patient experienced ipsilateral carotid territory TIA and another patient experienced contralateral carotid territory TIA. DSA follow up of 5 patients demonstrated 1 case with in-stent restenosis and arterial kinking remote to the stent of internal carotid artery. CAS were performed again and CT angiography follow up demonstrated no kinking and restenosis 2 years after the intervention. Duplex scan of the other 7 patients demonstrated neither kinking nor restenosis.
  
  
  CONCLUSIONS
  CAS seems to be feasible and safe for the patients with symptomatic kinking and stenosis, and maybe helpful to lower the risk of cerebral ischemia, but further study is needed.
authors.affiliation: Department of Neurosurgery, Beijing Hospital, China.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Wang
authors.forename: Da-Ming
authors.initials: DM
authors.lastname: Wang
authors.forename: Jia-Chun
authors.initials: JC
authors.lastname: Liu
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.forename: Peng
authors.initials: P
authors.lastname: Qi
authors.forename: Da
authors.initials: D
authors.lastname: Li
authors.forename: Xue-Li
authors.initials: XL
authors.lastname: Jiang
authors.forename: Le-le
authors.initials: LL
authors.lastname: Zhai
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D016893:Carotid Stenosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome