Purpose:To evaluate the feasibility, safety, and efficacy of intravascular stents in the treatment of extracranial carotid artery occlusive disease.Methods:According to protocol, stent therapy was offered to symptomatic patients with ≥ 70% arteriographically defined carotid stenoses or ulcerative lesions and, after September 1994, to asymptomatic patients with ≥ 75% stenoses. From April 1993 to September 1995, 110 nonconsecutive patients (79 males; mean age 72 years, range 45 to 85) consented to participate in the study. The majority (79 [72%]) were asymptomatic. Lesions meeting the treatment criteria were in the proximal common (n = 3); mid common (n = 12); distal common (n = 8); internal (ICA) (n = 92); and external (n = 2) carotid arteries. Seven patients had bilateral ICA stenoses, and 17 patients were treated for postsurgical recurrent disease. The mean lesion length and diameter stenosis for all lesions were 12.4 ± 9.2 mm and 86.5% ± 10.6%, respectively.The procedures were performed either via direc...

Stenting in the carotid artery: initial experience in 110 patients.

Transluminal angioplasty for hemodynamically significant stenosis (> 70%) involving the posterior cerebral circulation is now being performed by the authors in selected cases. A total of 42 lesions affecting the vertebral or basilar artery have been successfully treated by percutaneous transluminal angioplasty techniques in 41 patients. The lesions involved the proximal vertebral artery in 34 cases, the distal vertebral artery in five, and the basilar artery in three. Patients were examined clinically at 1 to 3 and 6 to 12 months after angioplasty. Three (7.1%) permanent complications occurred, consisting of stroke in two cases and vessel rupture in one. There were four (9.5%) transient complications (< 30 minutes): two cases of vessel spasm and two of cerebral ischemia. Clinical follow-up examination demonstrated improvement of symptoms in 39 cases (92.9%). Radiographic follow-up studies demonstrated three cases (7.1%) of restenosis involving the proximal vertebral artery; two were treated by repeat angioplasty without complication, and the third is being followed clinically while the patient remains asymptomatic. In patients with significant atherosclerotic stenosis involving the vertebral or basilar artery territories, transluminal angioplasty may be of significant benefit in alleviating symptoms and improving blood flow to the posterior cerebral circulation.

Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries

Percutaneous transluminal angioplasty for treatment of intracerebral arterial vasospasm is now being performed in selected cases. Thirty-six vascular territories in 13 patients, ranging in age from 15 to 73 years, have been treated with a new silicone microballoon device. This balloon has allowed mechanical dilatation of segmental and diffuse areas of spastic intracerebral blood vessels less than 1 mm in diameter with return to normal luminal diameter. Follow-up angiography has documented improved cerebral perfusion without return of spasm. In 10 patients (77%), vasospasm was due to subarachnoid hemorrhage following rupture of an intracranial aneurysm. In three patients (23%), spasm with resultant neurological decline occurred during detachable balloon embolization therapy for treatment of an aneurysm. In each case, the vessel caliber returned to normal size following balloon dilatation. In nine (69%) of the 13 cases, balloon dilatation resulted in improvement of neurological function within minutes to hours following the procedure. Transluminal angioplasty techniques may offer an alternative form of therapy in the management of symptomatic arterial vasospasm.

Transluminal angioplasty for treatment of intracranial arterial vasospasm

Percutaneous transluminal angioplasty (PTA) of carotid arteries has been rarely reported. Dilatation of internal carotid artery stenosis has so far been performed only for fibromuscular dysplasia. Because of the risk of cerebral embolization the technique has not been used for arteriosclerotic stenosis, particularly since endarterectomy is known as a safe procedure. Three cases are reported of successful dilatation of arteriosclerotic internal carotid artery stenosis. A neurologic complication occurred in one patient. The primary indication for performing PTA in such cases is limited operability for medical reasons.

http://www.ajnr.org/content/ajnr/4/3/791.full.pdf

Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis

Our common interest in surgery of the vertebral artery was born in 1976, when as residents in the same hospital, we attended an attempt by two senior surgeons to treat an aneurysm of the vertebral artery at the C 3 level. Long discussions had preceded this unsuccessful trial, to decide if surgery was indicated and to choose the surgical route. Finally a direct lateral approach was performed, but access was difficult and correct treatment was impossible, resulting in only partial reduction of the aneurysmal pouch. Following this experience, we decided to seek a regular and well defined approach for exposition of the vertebral artery. Review of the literature indicated some surgical attempts, but the descriptions did not give the impression of safety and reproducibility. No landmark on the described surgical route appeared sufficiently reliable. Henry's anatomical work (1917) gave the only accurate description on vertebral artery anatomy, and it became the basis for our work. When the same patient was referred again one year later, after a new stroke in the vertebro-basilar system, we had behind us repetitive experience on cadavers of an original approach to the distal vertebral artery.

The Vertebral Artery

Percutaneous transluminal angioplasty was used to successfully dilate critical narrowings of the internal carotid artery caused by fibromuscular dysplasia. The technique of this new procedure is presented along with the angiographic findings and results in three patients. Angioplasty may be used as an alternative to open arteriotomy and graduated dilatation in treating stenosis due to symptomatic fibromuscular dysplasia in the immediate extracranial part of the internal carotid artery.

Fibromuscular dysplasia of the internal carotid artery: percutaneous transluminal angioplasty.

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Fibromuscular dysplasia of the internal carotid artery: percutaneous transluminal angioplasty.