Stent with carotid angioplasty

One patient developed post-procedural transient ischemia (TIA), but no permanent neurological complications occurred in this series. No deaths were attributable to ERCA although one death occurred within the 30-day perioperative period. Specifically, one patient with advanced HNC (Group III) died from complications of disease progression (pulmonary embolus) on the fourth post-operative day. These complication rates were comparable or lower than those previously reported for endovascular deconstructive techniques and stent-assisted carotid angioplasty of atherosclerotic disease [4, 21, 51]. 

Carotid angioplasty with or without stenting is typically restricted to patients who are refractory to medical therapy and are not surgical candidates. Clinical trials are currently ongoing to further define the role of carotid angioplasty in both symptomatic and asymptomatic patients. 

Randomized trial data suggest that unprotected carotid angioplasty can be performed with results comparable to those of CEA (5,6), and some authors have suggested that filter-type EPDs use might be associated with an increased propensity to embolism (38), Nevertheless, we believe that utilization of embolic protection should be considered the standard of care in carotid stenting. When use of an EPD is precluded by anatomical factors, alternative treatment strategies (CEA, medical therapy) must be strongly considered. 

Parodi JC, La Mura R, Ferreira LM, et al. Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices. J Vase Surg 2000 32 1127-1136. 

Guimaraens L, Sola MT Matali A, et al. Carotid angioplasty with cerebral protection and stenting report of 164 patients (194 carotid percutaneous transluminal angioplasties). Cerebrovasc Dis 2002 13 1 14-1 19. 

MasJL, ChatellierG, Beyssen B. Carotid angioplasty and stenting with and without cerebral protection clinical alert from the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S) trial. Stroke 2004 35 el8-20. 

KastrupA, Groschel K, KrapfH, Brehm BR, DichgansJ, Schulz JB. Early outcome of carotid angioplasty and stenting with and without cerebral protection devices a systematic review of the literature, Stroke 2003 34 813-81 9. 

Vos JA, van den BergJC, Ernst SM, et al. Carotid angioplasty and stent placement comparison of transcranial Doppler US data and clinical outcome with and without filtering cerebral protection devices in 509 patients. Radiology 2005 234 493 -99,... 

With the increasing use of stent-assisted angioplasty for the treatment of extracranial carotid occlusive disease, it is becoming more widely acknowledged that such endovascular reconstructive techniques can be performed with a relatively low rate of peri-operative cerebral ischemic complications [42, 49-52]. These ischemic complications, on average appear to be lower than those for therapeutic occlusion of the carotid artery using either open or endovascular techniques. 

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