Abstract
Recently, stenting for cervical internal carotid artery (ICA) stenoses has been performed not only in the high-risk patients of carotid endarterectomy (CEA) but also in patients amenable to CEA. We report clinical results of 96 patients of cervical ICA stenoses (99 lesions) and the effects of our recent method using the blocking balloon catheter system (BBCS) to prevent distal embolism. Stent placement was performed under local anesthesia via the percutaneous transfemoral route.
In 37 early patients (37 lesions), we used BBCS only during postdilatation (group A). In contrast, we used BBCS during predilatation as well as during postdilatation in 45 late patients with 47 lesions (group B). In 96 patients, the mean stenosis rate before stenting, 80.0%, markedly decreased to 7.7% after the procedure. At 30 days, the morbidity, neurological deficit and mortality rates were 4.2%, 1.0% and 1.0%, respectively. Two (2.4%) of 81 cases showed distal embolism when BBCS was used, while distal embolism occurred in 4 (27%) of 15 cases of stenting without BBCS. On diffuson-weighted MRI (DWI), hyperintense areas were detected in 7 (47%) of 15 lesions of group A and in 3 (19%) of 16 lesions of group B. Therefore, use of BBCS during predilatation as well as postdilatation (group B) reduced hyperintense areas on DWI further. Moreover, despite the more complex procedures, the use of BBCS during predilatation did not seem to increase morbidity, neurological deficits or mortality at 30 days.
To summarize, stenting with BBCS for cervical ICA stenosis is an effective treatment with low morbidity and mortality rates. Both predilatation and postdilatation using BBCS are useful techniques for reducing risk of distal embolism on DWI.
