Percutaneous transluminal angioplasty for cervical carotid artery stenosis

Abstract

Percutaneous transluminal angioplasty (PTA) was attempted in 16 patients (17 procedures) with cervical internal carotid artery (ICA) stenosis. Among the 16 patients, 14 were male and 2 were female aged from 44 to 76 years (average 63.4 years). One had cerebral infarction on the acute stage, and the other 15 were in the chronic stage. On CT scan and MRI, there were nine multiple lacunar infarctions and seven watershed infarctions. On angiographical findings, 13 had Rt.-ICA stenosis and 4 had Lt.ICA stenosis. Stenotic lesion existed beyond the level of the third cervical vertebral body in eleven cases, and so-called long segmental stenosis ranged from 3 to 5 cervical vertebral bodies in 3 cases. Before PTA, 14 patients underwent a balloon occlusion test for 3 to 20 minutes (average 9 minutes). Neurological symptoms of hemiparesis or sensory disturbance occurred in 3 patients during balloon inflation, but these disappeared completely after balloon deflation. It took from 1.5 to 2 hours (average 1.7 hours) to carry out PTA including the balloon occlusion test. All cases had satisfactory results with no morbidity or mortality. The mean stenosis ratio of pre-PTA, approximately 80% (55-93%), improved to that of 22% (0-50%) after PTA. Bradycardia and hypotension occurred transiently in 9 cases during and after PTA, but no symptoms remained by atropine sulfate and catecholamine infusion intravenously. In the following 1 to 26 months (mean 9.0 months) after PTA, 3 cases restenosed. The restenosis was recognized by MR angiography after 8 to 26 months (average 15.7 months) of PTA. One case had PTA again, and CEA was performed on the other 2 cases. Our experience has shown that PTA of an ICA lesion is an applicable form of treatment. PTA may be the first-choice therapy for high risk patients or surgically inaccessible high lesions of the ICA. With further improvement of the balloon catheter systems, PTA may become the first-choice therapy for carotid artery stenosis instead of CEA.