The carotid PTA and/or STENT placement for the carotid stenosis is an alternative treatment especially in patients with high-position stenosis, associated coronary artery disease and special condition of stenosis such as post irradiation stenosis or post carotid endoarterectomy (CEA) stenosis.
Bilateral carotid disease is also a high-risk condition of CEA stenosis. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) demonstrated that the perioperative rate of stroke and death is 14.3% if the contralateral artery is occluded. We treated with PTA and/or STENT placement 10 patients with bilateral carotid artery occlusive disease. In 3 cases, the contralateral carotid arteries were occluded, and in the other 7 cases, the bilateral carotid arteries had severe stenosis. All patients were symptomatic, and the angiographical percentages of the stenosis ranged from 70% to 99%.
We performed 18 procedures of PTA and/or STENT placement and 6 procedures of CEA for 17 carotid stenotic lesions. In every case PTA and/or STENT placement was performed as a prior treatment for the symptomatic lesion. One minor stroke occurred during the PTA caused by a procedure-related complication (7.1%) but no major strokes occurred in this series. In surgical high-risk groups such as bilateral carotid artery occlusive disease, the combination of PTA/STENT and CEA is useful to prevent and reduce perioperative ischemic complications.
