Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis

Giuseppe Lanzino, Robert A. Mericle, Demetrius K. Lopes, Ajay K. Wakhloo, Lee R. Guterman, L. Nelson Hopkins

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Object. Treatment consisting of percutaneous transluminal angioplasty (PTA) and stent placement has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stent placement for carotid artery restenosis. Methods. The mean interval between endarterectomy and the endovascular procedures was 57 months (range 8-220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stent placement in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event, and in one patient a pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6-57 months). Three of five patients who underwent PTA alone developed significant (> 50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stent placement in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty and stent placement. Conclusions. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.

Original languageEnglish (US)
Pages (from-to)688-694
Number of pages7
JournalJournal of Neurosurgery
Volume90
Issue number4
StatePublished - Apr 1999
Externally publishedYes

Fingerprint

Carotid Stenosis
Angioplasty
Stents
Endarterectomy
Arteries
Endovascular Procedures
False Aneurysm
Femoral Artery
Carotid Arteries
Pathologic Constriction
Safety

Keywords

  • Angioplasty
  • Carotid endarterectomy
  • Carotid restenosis
  • Stenting

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Lanzino, G., Mericle, R. A., Lopes, D. K., Wakhloo, A. K., Guterman, L. R., & Hopkins, L. N. (1999). Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis. Journal of Neurosurgery, 90(4), 688-694.

Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis. / Lanzino, Giuseppe; Mericle, Robert A.; Lopes, Demetrius K.; Wakhloo, Ajay K.; Guterman, Lee R.; Hopkins, L. Nelson.

In: Journal of Neurosurgery, Vol. 90, No. 4, 04.1999, p. 688-694.

Research output: Contribution to journalArticle

Lanzino, G, Mericle, RA, Lopes, DK, Wakhloo, AK, Guterman, LR & Hopkins, LN 1999, 'Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis', Journal of Neurosurgery, vol. 90, no. 4, pp. 688-694.
Lanzino G, Mericle RA, Lopes DK, Wakhloo AK, Guterman LR, Hopkins LN. Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis. Journal of Neurosurgery. 1999 Apr;90(4):688-694.
Lanzino, Giuseppe ; Mericle, Robert A. ; Lopes, Demetrius K. ; Wakhloo, Ajay K. ; Guterman, Lee R. ; Hopkins, L. Nelson. / Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis. In: Journal of Neurosurgery. 1999 ; Vol. 90, No. 4. pp. 688-694.
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abstract = "Object. Treatment consisting of percutaneous transluminal angioplasty (PTA) and stent placement has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stent placement for carotid artery restenosis. Methods. The mean interval between endarterectomy and the endovascular procedures was 57 months (range 8-220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stent placement in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event, and in one patient a pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6-57 months). Three of five patients who underwent PTA alone developed significant (> 50{\%}) asymptomatic restenoses that required repeated angioplasty in one and PTA with stent placement in two patients. Significant restenosis (55{\%}) was observed in only one of the vessels treated by combined angioplasty and stent placement. Conclusions. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.",
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AU - Lopes, Demetrius K.

AU - Wakhloo, Ajay K.

AU - Guterman, Lee R.

AU - Hopkins, L. Nelson

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