(Circulation. 1997;95:376-381.)
© 1997 American Heart Association, Inc.
Articles |
Elective Stenting of the Extracranial Carotid Arteries
the Department of Medicine, divisions of Cardiovascular Diseases (J.S.Y., G.S.R., S.I.), Neurology (J.S.Y., P.K.), Radiology (J.V.), Vascular Surgery (W.D.J.), and Neurosurgery (W.S.F.), University of Alabama at Birmingham.
Background Surgical endarterectomy has been shown to be superior to medical management in the management of severe carotid stenosis in both symptomatic and asymptomatic patients. Endarterectomy, although effective, does have limitations, and percutaneous techniques may offer an alternative method of treatment.
Methods and Results The feasibility and safety of percutaneous carotid angioplasty and elective (primary) stenting was evaluated prospectively in a consecutive series of 107 patients. One hundred twenty-six carotid arteries with significant stenosis were treated. This series represented a high-risk subset that included patients with previous ipsilateral endarterectomy and severe medical comorbidity. Forty-five percent of the patients were referred by surgeons. Patients had independent neurological examinations before and after the procedure and follow-up cerebral angiography at 6 months. The mean (±SD) stenosis was reduced from 78±14% to 2±5%. There were 7 minor strokes, 2 major strokes, and 1 death during the initial hospitalization and first 30 days after the procedure. For the combined end point of all strokes and death, the incidence was 7.9%. For ipsilateral major stroke and death, the incidence was 1.6%. There were no strokes during the follow-up period. Mean angiographic stenosis at 6 months in 81 patients was 18±16% (range, -21% to 57%). Four (4.9%) of these 81 patients had asymptomatic restenosis. Five asymptomatic patients had repeat intervention: 2 had angioplasty for restenosis, 2 had angioplasty for stent deformation, and 1 had endarterectomy for restenosis.
Conclusions In a high-risk group of patients, percutaneous carotid angioplasty and stenting are feasible and can be performed with low restenosis and repeat intervention rates.
Key Words: carotid arteries • stents • carotid endarterectomy
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T. J. Tegos, E. Kalodiki, and A. N. Nicolaides Stroke: Management and Rehabilitation: Part III of III Angiology, December 1, 2000; 51(12): 977 - 984. [Abstract] [PDF]
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A. M. Malek, R. T. Higashida, C. C. Phatouros, T. E. Lempert, P. M. Meyers, W. S. Smith, C. F. Dowd, and V. V. Halbach Stent Angioplasty for Cervical Carotid Artery Stenosis in High-Risk Symptomatic NASCET-Ineligible Patients Stroke, December 1, 2000; 31(12): 3029 - 3033. [Abstract] [Full Text] [PDF]
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W. Morrish, S. Grahovac, A. Douen, G. Cheung, W. Hu, R. Farb, P. Kalapos, R. Wee, M. Hudon, C. Agbi, et al. Intracranial Hemorrhage after Stenting and Angioplasty of Extracranial Carotid Stenosis AJNR Am. J. Neuroradiol., November 1, 2000; 21(10): 1911 - 1916. [Abstract] [Full Text] [PDF]
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C. C. Phatouros, R. T. Higashida, A. M. Malek, P. M. Meyers, T. E. Lempert, C. F. Dowd, and V. V. Halbach Carotid Artery Stent Placement for Atherosclerotic Disease: Rationale, Technique, and Current Status Radiology, October 1, 2000; 217(1): 26 - 41. [Abstract] [Full Text]
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F. Shawl, W. Kadro, M. J. Domanski, F. L. Lapetina, A. A. Iqbal, K. G. Dougherty, D. D. Weisher, J. F. Marquez, and S. T. Shahab Safety and efficacy of elective carotid artery stenting in high-risk patients J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1721 - 1728. [Abstract] [Full Text] [PDF]
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G. Dangas, J. R. Laird Jr, L. F. Satler, R. Mehran, G. S. Mintz, G. Larrain, A. J. Lansky, L. Gruberg, E. M. Parsons, R. Laureno, et al. Postprocedural Hypotension after Carotid Artery Stent Placement: Predictors and Short- and Long-term Clinical Outcomes Radiology, June 1, 2000; 215(3): 677 - 683. [Abstract] [Full Text]
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J. Golledge, A. Mitchell, R. M. Greenhalgh, and A. H. Davies Systematic Comparison of the Early Outcome of Angioplasty and Endarterectomy for Symptomatic Carotid Artery Disease Stroke, June 1, 2000; 31(6): 1439 - 1443. [Abstract] [Full Text] [PDF]
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C. R. Gomez, V. K. Misra, M. S. Campbell, and R. D. Soto Elective Stenting of Symptomatic Middle Cerebral Artery Stenosis AJNR Am. J. Neuroradiol., May 1, 2000; 21(5): 971 - 973. [Abstract] [Full Text]
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 Carotid angioplasty and stenting: current status Can. Med. Assoc. J., May 1, 2000; 162(10): 1451 - 1454.
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C. C. Phatouros, R. T. Higashida, A. M. Malek, P. M. Meyers, T. E. Lempert, C. F. Dowd, and V. V. Halbach Endovascular Stenting for Carotid Artery Stenosis: Preliminary Experience Using the Shape-memory-Alloy-recoverable-technology (SMART) Stent AJNR Am. J. Neuroradiol., April 1, 2000; 21(4): 732 - 738. [Abstract] [Full Text]
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I. D. Wilkinson, P. D. Griffiths, N. Hoggard, T. J. Cleveland, P. A. Gaines, and G. S. Venables Unilateral Leptomeningeal Enhancement After Carotid Stent Insertion Detected by Magnetic Resonance Imaging Stroke, April 1, 2000; 31(4): 848 - 851. [Abstract] [Full Text] [PDF]
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J. J. Connors III, D. Seidenwurm, J. C. Wojak, R. W. Hurst, M. E. Jensen, R. Wallace, T. Tomsick, J. Barr, C. Kerber, E. Russell, et al. Treatment of Atherosclerotic Disease at the Cervical Carotid Bifurcation: Current Status and Review of the Literature AJNR Am. J. Neuroradiol., March 1, 2000; 21(3): 444 - 450. [Full Text]
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E. J. Topol and J. S. Yadav Recognition of the Importance of Embolization in Atherosclerotic Vascular Disease Circulation, February 8, 2000; 101(5): 570 - 580. [Full Text] [PDF]
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C. R. Gomez, V. K. Misra, M. W. Liu, V. R. Wadlington, J. B. Terry, R. Tulyapronchote, and M. S. Campbell Elective Stenting of Symptomatic Basilar Artery Stenosis Stroke, January 1, 2000; 31(1): 95 - 99. [Abstract] [Full Text] [PDF]
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D. J. H. McCabe, M. M. Brown, and A. Clifton Fatal Cerebral Reperfusion Hemorrhage After Carotid Stenting Stroke, November 1, 1999; 30 (11): 2483 - 2486. [Abstract] [Full Text] [PDF]
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P. P. Morris, E. M. Martin, J. Regan, and G. Braden Intracranial Deployment of Coronary Stents for Symptomatic Atherosclerotic Disease AJNR Am. J. Neuroradiol., October 1, 1999; 20(9): 1688 - 1694. [Abstract] [Full Text]
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A. M. Malek, R. T. Higashida, C. C. Phatouros, T. E. Lempert, P. M. Meyers, D. R. Gress, C. F. Dowd, and V. V. Halbach Treatment of Posterior Circulation Ischemia With Extracranial Percutaneous Balloon Angioplasty and Stent Placement Stroke, October 1, 1999; 30(10): 2073 - 2085. [Abstract] [Full Text] [PDF]
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A. I. Qureshi, A. R. Luft, M. Sharma, V. Janardhan, D. K. Lopes, J. Khan, L. R. Guterman, and L. N. Hopkins Frequency and Determinants of Postprocedural Hemodynamic Instability After Carotid Angioplasty and Stenting Stroke, October 1, 1999; 30(10): 2086 - 2093. [Abstract] [Full Text] [PDF]
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T. Mori, K. Kazita, T. Mima, and K. Mori Balloon Angioplasty for Embolic Total Occlusion of the Middle Cerebral Artery and Ipsilateral Carotid Stenting in an Acute Stroke Stage AJNR Am. J. Neuroradiol., September 1, 1999; 20(8): 1462 - 1464. [Abstract] [Full Text]
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H. I. Manninen, H. T. Räsänen, R. L. Vanninen, P. Vainio, M. Hippeläinen, and V.-M. Kosma Stent Placement versus Percutaneous Transluminal Angioplasty of Human Carotid Arteries in Cadavers in Situ: Distal Embolization and Findings at Intravascular US, MR Imaging, and Histopathologic Analysis Radiology, August 1, 1999; 212(2): 483 - 492. [Abstract] [Full Text]
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 G. Babatasi, M. Massetti, and J. Theron Coexistent coronary and cerebrovascular disease: a place for carotid stenting Ann. Thorac. Surg., July 1, 1999; 68(1): 297 - 297. [Full Text] [PDF]
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Mori, Kazita, and Mori Cerebral Angioplasty and Stenting for Intracranial Vertebral Atherosclerotic AJNR Am. J. Neuroradiol., May 1, 1999; 20(5): 787 - 789. [Abstract] [Full Text]
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M. P. Marks, M. Marcellus, A. M. Norbash, G. K. Steinberg, D. Tong, and G. W. Albers Outcome of Angioplasty for Atherosclerotic Intracranial Stenosis Stroke, May 1, 1999; 30(5): 1065 - 1069. [Abstract] [Full Text] [PDF]
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P. Hadjipetrou, S. Cox, T. Piemonte, and A. Eisenhauer Percutaneous revascularization of atherosclerotic obstruction of aortic arch vessels J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1238 - 1245. [Abstract] [Full Text] [PDF]
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M. R. Lepore, W. D. Jordan Jr, W. S. Fisher, D. C. Voellinger, D. Redden, and H. A. McDowell Treatment of Recurrent Carotid Stenosis: Angioplasty with Stenting versus Reoperative Carotid Surgery Vascular and Endovascular Surgery, November 1, 1998; 32(6): 523 - 530. [Abstract] [PDF]
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J. T. Robertson Carotid Endarterectomy: A Saga of Clinical Science, Personalities, and Evolving Technology : The Willis Lecture Stroke, November 1, 1998; 29(11): 2435 - 2441. [Full Text] [PDF]
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G. Dorros Stent-Supported Carotid Angioplasty : Should It Be Done, and, If So, by Whom? A 1998 Perspective Circulation, September 1, 1998; 98(9): 927 - 930. [Full Text] [PDF]
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G. S. Roubin Dear Editor-in-Chief: AJNR Am. J. Neuroradiol., August 1, 1998; 20(7): 1378 - 1381. [Full Text]
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A. Mathur, G. S. Roubin, S. S. Iyer, C. Piamsonboon, M. W. Liu, C. R. Gomez, J. S. Yadav, H. D. Chastain, L. M. Fox, L. S. Dean, et al. Predictors of Stroke Complicating Carotid Artery Stenting Circulation, April 7, 1998; 97(13): 1239 - 1245. [Abstract] [Full Text] [PDF]
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