Endovascular Treatment for Cervical Internal Carotid Stenosis

Abstract

Recent development of endovascular devices such as balloon catheter and stents enabled neurointerventional treatment of carotid stenosis. We introduce our methods of carotid stenting in this paper. Initially, we deployed stents without protection devices and experienced 3 neurological complications (1 major stroke and 2 transient neurological deficits). After that, we developed a novel protective balloon catheter that occluded the distal internal carotid artery and was navigated under guidewire control. Our second method was to deploy stents after predilataion for the internal carotid stenosis using a smaller PTA balloon catheter and expand the stent under protection. The debri or clot that might appear during post dilation was aspirated and rinsed to the external carotid artery by a catheter introduced from the contralateral femoral artery. This method was applied for 37 lesions; transient neurological deficit due to embolic complication appeared in 1 case during the period of predilation.
Then, we started to use a protective balloon including the process of predilation. Initially, the protective balloon catheter was navigated distal portion of the stenosis under guidewire control. Then the guidewire was retrieved to be detached from the protective balloon catheter at the distal portion of the stenosis. The balloon was inflated at the distal internal carotid artery and a PTA balloon catheter was introduced into the stenotic portion and the stenosis was fully dilated. The guidewire was withdrawn and the occluded lumen of the internal carotid artery was rinsed by saline and debri and clot were washed to the external carotid artery. Then, protective balloon was deflated and the guidewire was introduced into the PTA balloon and PTA balloon was withdrawn. Finally a stent was deployed to cross the lesion. Twenty-four lesions were treated with this method without neurological complication. Postdilation under balloon protection was added only for two of 24 cases. This method was simple and effective to prevent embolic complications.