Stenting for Extracranial Carotid Artery Stenosis

Clinical results of our experience on stenting for extracranial carotid stenosis are reported. The subjects were 87 lesions(85 patients)of severe stenosis of the extracranial carotid artery treated with stenting between August 1997 and March 2000. Subjects consisted mainly of patients excluded from carotid endarterectomy according to the criteria of NASCET and ACAS : elderly patients, patients with severe cardiopulmonary complications, patients with contralateral occlusion or severe stenosis, patients with concomitant tandem lesions, and restenosis after carotid endarterectomy. The technical success rate was 85/87(97.7%), and all the successful cases showed sufficient patency rates(80% or more). Rate of complications were 2.3% for permanent deficits(severe cerebral infarction, 1 ; mild cerebral infarction, 1), and 8.0% for temporary deficits(TIA, 4 ; RIND, 3), and most of them were experienced in the first half experience. Based on these, we focused on 1)evaluating the plaque property during determination of indications, 2)introducing a distal protective balloon, and 3)avoiding unreasonable complete dilatation. These modifications provided significant reduction in complication rate. Stenting for extracranial carotid artery stenosis is considered a promising less invasive treatment for occlusive cerebrovascular diseases in the aging society. However, there are many problems to be solved : establishment of its significance in stroke prevention including a long-term outcome, development of stents suitable for the cervical carotid artery and effective protective systems for distal thromboembolism, and measures against restenosis.