Endovascular Treatment of Carotid Artery Stenosis with Cerebral Protection: 5-year Experience
Authors:
Miroslav Lojík 1; D. Krajíčková 2; M. Kubíková 2; A. Krajina 1; J. Raupach 1; V. Chovanec 1; J. Schreiberová 3
Authors‘ workplace:
Radiologická klinika LF a FN, Hradec Králové, přednosta: prof. MUDr. P. Eliáš, CSc.
1; Neurologická klinika LF a FN, Hradec Králové, přednosta: doc. MUDr. G. Waberžinek, CSc.
2; Klinika anesteziologie, resuscitace a intenzivní medicíny, LF a FN, Hradec Králové
přednosta: doc. MUDr. V. Černý, Ph. D., FCCM
3
Published in:
Rozhl. Chir., 2007, roč. 86, č. 10, s. 513-520.
Category:
Monothematic special - Original
Overview
Background:
Percutaneous transluminal angioplasty and stenting with cerebral protection is a minimally invasive method for carotid artery stenosis treatment, which may be an alternative to surgical endarterectomy. The aim of our study is to evaluate results of endovascular treatment in patients at high risk of endarterectomy.
Patients and methods:
Between years 2001–2006, 210 carotid artery stenoses in 204 patients were treated in our department. Fourty seven percent of patients suffered from symptomatic stenosis, asymptomatic stenosis was proved in 53% of patients. All asymptomatic patients had stenosis more than 70 % measured according to NASCET, mostly with contralateral carotid artery occlusion.
Results:
The procedure was technically successful in 99% of patients, mortality was 0.49%. Periprocedural embolic complications based on transient ischemic attack were observed in 2.39% of patients, symptoms of minor stroke in 0.47% and symptoms of major stroke in 0.47% of patients. The mortality and disabled morbidity rate in the whole group was 0.96%. One hundred and fifty three patients (73%) were followed up, during this time, 7 patients (3.9%) developed hemodynamically significant restenosis.
Conclusion:
Endovascular carotid artery stenosis treatment with cerebral protection seems to be a safe method of treatment with acceptable short-term results. However, long-term follow – up is needed to get enough data about safety and effectiveness of this method compared to endarterectomy and best medical therapy.
Key words:
carotid artery stenosis – cerebral protection – complications
Sources
1. Mohr, J. P., Gautier, J. Internal carotid artery disease. In: Mohr, J. P., editor. Stroke_ Pathophysiology, diagnosis, and management. Philadelphia, P. A.: Churchill Livingstone, 2004, s. 75–200.
2. Muluk, S. C., Muluk, V. S., Sugimoto, H., et al. Progression of asymptomatic carotid stenosis: a natural history study in 1004 patient. J. Vasc. Surg, 1999, roč. 29, s. 208–214.
3. North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis. N. Engl. J. Med., 1991, roč. 325, s. 445–453.
4. Barnett, H. J., Taylor, D. W., Eliasziw, M., et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N. Engl. J. Med., 1998, roč. 339, s. 1415–1425.
5. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA, 1995, roč. 273, s. 1421–1428.
6. Halliday, A., Mansfield, A., Marro, J., et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet, 2004, roč. 363, s. 1491–1502.
7. Eagle, K. A., Guyton, R. A., Davidoff, R., et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery) Available at: http://www.cardiosource.com/guidelines/browse.asp?-topicID=7.
8. Bates, E. R., Babb, J. D., Casey, D. E. Jr., Cates, C. U., Duckwiller, G. R., Feldman, T. E., Gray, W. A., Ouriel, K., Peterson, E. D., Rosenfield, K., Rundback, J. H., Safian, R. D., Sloan, M. A., White, C. J., American College of Cardiology Foundation Task Force, American Society on Interventional Therapeutic Neuroradiology, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society for Interventional Radiology. ACCF/SCAI/SVMB/SIR, ASITN 2007 clinical expert consensus document on carotid stenting. J. Am. Coll. Cardiol., 2007, roč. 49, č. 1, s. 126–170.
9. Rothwell, P. M., Warlow, C. P., on behalf of the European Carotid Surgery Trialists‘ Collaborative Group Low risk of ischemic stroke in patients with reduced internal carotid artery lumen diameter distal to severe symptomatic carotid stenosis: cerebral protection due to low poststenotic flow? Stroke, 2000, roč. 31, s. 622–630.
10. Chaturvedi, S. Should the multicenter carotid endarterectomy trials be repeated? Arch. Neurol., 2003, roč. 60, s. 774–775.
11. Rothwell, P. M., Slattery, J., Warlow, C. P. A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. Stroke, 1996, roč. 27, s. 260–265.
12. Roubin, G. S., Iyer, S., Halkin, A., Vitek, J., Brennan, C. Realizing the potential of carotid artery stenting proposed paradigms for patient selection and procedural technique. Circulation, 2006, roč. 113, s. 2021–2030.
13. Babatasi, G., Massetti, M., Theron, J., Khayat, A. Asymptomatic Carotid Stenosis in Patients Undergoing Major Surgery: Can Percutaneous Carotid Angioplasty be an Alternative? European Journal of Cardio-Thoracic Surgery, 1997, roč. 11, s. 547–553.
14. Yadav, J. S., Roubin, G. S., Iyer, S., et al. Elective Stenting of the External Carotid Arteries. Circulation, 1997, roč. 95, s. 376–381.
15. Yadav, J. S., Roubin, G. S., King, P., Iyer, S., Vitek, J. J. Angioplasty nad Stenting for Restenosis after Carotid Endarterectomy. Stroke, 1996, roč. 27, s. 1733–1740.
16. Becker, G. J. Should Metallic Vascular Stent Be Used to Treat Cerebrovascular Occlusive Diseases? Radiology, 1994, roč. 191, s. 309–312.
17. Belán, A., Veselá, M., Vaněk, I., Weiss, K., Peregrin, J. H.Percutaneous Transluminal Angioplasty of Fibromuscular Dysplasia of the Internal Carotid Artery. Cardiovasc. Intervent. Radiol., 1982, roč. 5, s. 79–81.
18. Laloux, P., Richelle, F., Meurice, H., De Coster, P. Cerebral Blood Flow and Perfusion Reserve Capacity in Hemodynamic Carotid Transient Attacks Due to Innominate Artery Stenosis. J. Nucl. Med., 1995, roč. 36, s. 1268–1271.
19. Biller, J., Feinberg, W. M., Castaldo, J. E., et al. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a Splecial Writing Group of the Stroke Council, American Heart Association. Circulation, 1998, roč. 97, s. 501–509.
20. Kastrup, A, Groschel, K., Krapf, H., et al. Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke, 2003, roč. 34, s. 813–819.
21. Hart, J. P., Peeters, P., Verbist, J., Deloose, K., Bosiers, M. Do device characteristics impact outcome in carotid artery stenting? J. Vasc. Surg., 2006, roč. 44, s. 725–730.
22. Wholey, M. H., Al-Mubarek, N., Wholey, M. H. Updated review of the global carotid artery stent registry. Catheter Cardiovasc. Interv., 2003, roč. 60, s. 259–266.
23. CAVATAS Investigators: Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet, 2001, roč. 357, s. 1729–1737.
24. McCabe, D. J. H., Pereira, A. C., Clinton, A., Bland J. M., Brown, M. M., on behalf of the CAVATAS Investigators Restenosis After Carotid Angioplastyy, Stenting, or Endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS). Stroke, 2005, roč. 36, s. 281–293.
25. Younis, G. A., Gupta, K., Mortazavi, A., Strickman, N. E. Predictors of Carotid Stent Restenosis. Catheter Cardiovasc. Interv., 2007, roč 69, s. 673–682.
26. Coward, L. J., Featherstone, R. L., Brown, M. M. Safety and Efficacy of Endovascular Treatment of Carotid Artery Stenosis Compared With Carotid Endarterectomy. A Cochrane Systematic Review of the Randomised Evidence. Stroke, 2005, roč. 36, s. 905–911.
27. Yadav, J. S., Wholey, M. H., Kuntz, R. E., Fayad, P., et al. Protected Carotid–Artery Stenting versus Endarterectomy in high Risk-Patients. N. Engl. J. Med., 2004, roč. 351, č. 15, s. 1493–1501.
28. Yadav, J. S., Sneed, D., Ouriel, K., et al. Durability of carotid stenting for the prevention of stroke: 3-year follow-up of the SAPPHIRE trial and the US Carotid Feasibility (abstr). Circulation, 2005, roč. 112, suppl: II-416.
29. Ringleb, P. A., Kunze, A., Allenberg, J. R., et al. The stent-supported percutaneous angioplasty of the carotid artery vs. endarterectomy trial. Cerebrovasc. Dis., 2004, roč. 18, s. 66–68.
30. Ringleb, P. A., Allenberg, J. R., Bruckmann, H., et al. 30 day resuls from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet, 2006, roč. 368, s. 1215–1216.
31. Krajíčková, D., Krajina, A., Nová, M., Raupach, J. Fatal intraventricular hemorrhage after the extracranial carotid artery angioplasty and stent placement. Cardiovasc. Intervent. Radiol., 2005, roč. 28(4), s. 502–505.
32. Krajíčková, D., Krajina, A., Lojík, M., Jakubcová, O. Naše zkušenosti s angioplastikami mozkových tepen. Čes. a slov. Neurol. Neurochir., 2005, roč. 68/101, s. 241–250.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2007 Issue 10
Most read in this issue
- Biliary Ileus – A Rare Complication of Cholecystolithiasis
- Surgical Treatment of Breast Cancer in the Masaryk Memorial Cancer Institute
- Endovascular Treatment of Carotid Artery Stenosis with Cerebral Protection: 5-year Experience
- Tumorous Stem Cells – A Novel View in Oncology?