Carotid artery stenosis may lead to stroke if it is not managed. Success rates for carotid artery endarterectomy and carotid artery stenting are high and a great number of patients now are being treated successfully by these advanced procedures.

1. Carotid Artery Stenosis
Treatment Options

3. Treatment Options
Medical
 Surgical: Carotid Endarterectomy
 Endovascular: Carotid Stenting with Cerebral
Protection

4. Carotid Artery Disease
 Stroke rate: 200 / 100.000 per annum
 80% ischemic (20% hemorragic)
 50% have a carotid artery stenosis
 3rd leading cause of death
 Clinical symptoms caused by embolic disease in
> 80% of patients (< 20% by hemodynamic
impairment)

5. Carotid Artery Disease
Stroke Current Status in USA
 1.5 deaths per 1000
 Ranks 3 in cause of death
 > 500,000 strokes per annum in USA
 2 million survivors with need for ongoing care
 Carotid artery occlusive disease accounts for 20-30 all
strokes%

6. Surgical Treatment: Endarterectomy

7. Carotid Endarterectomy
Patch Grafting
 Reduced risk of acute
thrombosis
 Increased incidence of
use
 Lesser use of vein patch

8. Endovascular History
 Carotid Angioplasty:
 Kerber et al. 1980
 Theron et al. 1987
 48 pts, 4.1% serious morbidity
 Gil-Peralta et al. 1996
 82 pts, 0% mortality, 4.9% morbidity

9. Carotid Angioplasty
 Drawbacks:
 Vessel wall recoil
 Angiographically evident dissection
 Plaque dislodgement w/ embolisation
 Higher restenosis rates
 16%, versus 4% w/ stent (Theron, 1996)

10. Carotid Artery Stenting Success Rate
Technical success > 95%
Proc. related mortality: 0.6 – 4.5%
Major stroke rates : 0 – 4.5%
Minor stroke rates : 0 – 6.5%
6-mo restenosis < 5%
Phatouros et al., Neurol.Med.Chir., 1999, 39:809-827

11. Angioplasty Technical Success
N Tech
success
TIA Minor
Stroke
Major
Stroke
Death Restenosis >
50%
Roubin 238 96% 4% 2.3% 0.8% 0.5% 5% (6-mo)
Theron 259 94% 0% 2% 0% 0% 4% (1-yr)
Mathias 428 98% 2.3% 1.2% 0.3% 0.2% 9% (3-yr)
Bergeron 99 97% 4.1% 1% 0% 0% 3% (1yr)
Diethrich 238 91% 4.5% 2% 4.4% 1.5% 8% (2yr)
Gaines 251 96% 3.6% 4% 2.4%
Shawl,2000 170 99% 2.4% 0.5% 0.0% 2% (6-mo)
Peeters 90 96% 2.2% 2.2% 1.1% 2.2% 4% (1yr)

12. Embolisation May Occur During:
 Placement of guiding catheter into CCA
 Crossing the lesion
 Dilatation of the stenosis
 Stent implantation and dilatation

13. Cerebral Protection

14. Carotid Artery Stenting

15. Lesion Types
 Atherosclerotic lesions
 Non-atherosclerotic lesions:
 Fibromuscular Dysplasia (FMD)
 Infectious disease
 Dissection
 Radiated neck
 Recurrent stenosis after CEA
 Restenosis after PTA+stent
 Compression & Trauma

16. Case 1 - Before dilation

17. After Stenting

18. Case 2 - Before Dilation
 Very calcified
plaque

19. Case 2 – After Stenting & Post
Dilation
 Very calcified
plaque

20. Carotid Stent Angioplasty
,

21. Thank you