Percutaneous Transluminal Angioplasty and Stents in the Treatment of Extracranial Circulation

A feasibility study of stent supported angioplasty for the extracranial occlusive disease was conducted to include the carotid bifurcation and the internal carotid artery. One hundred seventy-four patients have undergone extra-cranial PTA and/or Meriting for occlusive disease involving the great vessels off the aortic arch, including the internal carotid. Sixty-one of the patients represented carotid occlusive disease, of which 15 were managed by PTA and 46 by intravascular Johnson & Johnson Interventional Systems stents. There were 13 vertebrals in the group, 7 innominate, 81 subclavian, 10 axillary lesions, and 2 grafts, I of which was an internal carotid interposi-tioned vein graft. The 61 patients that had carotid angioplasty and/or stents had a complication rate of 8%. However, 46 patients had a primary stenting procedure. From this group, 2 patients had minor strokes involving the upper extremities. One patient recovered fully within 24 hours, and the other had an 85% recovery at the end of a 1-week interval. Two patients encountered transient ischemic attacks. There were no deaths, and no major disabling strokes in the carotid series. The follow-up for the carotid stem group had a mean duration of only 2.5 months. Twenty-nine of the patients have been reevaluated with no new onset of neurological sequelae. There were no stent deformations noted as evaluated by three-dimensional computed tomographic angiography and color flow Doppler in addition to magnificant radiography. All patients have had 24-hour postoperative and 1-month color flow Doppler. All patients are required by protocol to undergo angiographic evaluation. If we include all extracranial interventions (174), a technical success of 93% was achieved in those patients undergoing PTA and 94% of those patients undergoing stenting procedures. Suboptitnal results were obtained in 6% of the PTA procedures, and 0% for stents. There is now sufficient data to document the efficacy of managing extracranial occlusive disease by percutaneous endovascutar stents. The exception, however, is the carotid bifurcation and the internal carotid artery, where a well-controlled feasibility study with careful analysis of the data will be necessary prior to randomizing the study against the gold standard of carotid endarterectomy.