Carotid stent-assisted angioplasty
We present the results of the first 33 patients who underwent carotid stent-assisted angioplasty at the Heart Unit of Panorama Medi-Clinic between March 1995 and June 1996. Intravascular stents (48 Palmaz-Schatz and 1 Wall stent) were deployed in the common carotid arteries (5) and internal carotid arteries (38) of both symptomatic (28 patients) and asymptomatic patients (5 patients) with > 60% stenosis (35 with > 70% and 6 with 60% stenosis). Thirteen patients underwent bilateral stent implantation, and had percutaneous transluminal coronary angioplasty or a peripheral and/or coronary stent implanted. Mean admission time was 2 days. Follow-up for 15 months (mean 9 months) employed clinical evaluation, duplex scanning at 6 and 12 months, and cerebral magnetic resonance imaging before, 48 hours and 6 months after the procedure. Angiographic success, defined as maximal residual stenosis < 10%, was achieved in 100%. Clinical success, defined as maximal residual stenosis < 10% and absence of death or recurrent transient ischaemic attack or stroke in hospital, was achieved in 97.7% of treated lesions. Complications included one procedure-related ipsi-lateral stroke and two angiography-related cerebellar infarcts. No transient ischaemic attacks or deaths occurred. No early or late restenoses have been observed to date. This experience with carotid stent-assisted angioplasty indicates that interventional neurovascular therapies may provide a useful alternative for selected patients requiring endoluminal reconstruction of carotid stenoses.