Carotid angioplasty with cerebral protection and carotid stents

Purpose: Endovascular treatment of carotid stenoses. Material and Method : 259 angioplasties of carotid stenosis are reported. The stenosis was an inflammatory stenosis or a restenosis post endarterectomy in 71 cases, atherosclerotic stenosis in 188 cases, Angioplasty was performed without cerebral protection in 123 cases including a group of 38 with atherosclerotic bifurcation stenosis. A cerebral protection (triple coaxial catheter) was used in 136 atherosclerotic bifurcation stenoses. Results : There has been no complication related to the procedure in the 71 cases of nonatherosclerotic stenosis and the 14 cases of proximal carotid and siphon atherosclerotic stenosis. There has been 5 % of dissection and 8 % embolic complication in the group of 38 atherosclerotic bifurcation cases treated without cerebral protection. There has been no embolic complication in the 136 atherosclerotic bifurcation cases treated with cerebral protection. There has been 5 % dissection in this group before stents and 0 % after stents have been used in less then satisfactory results (61 stents placed). Restenosis has also de creased after stents (15 % to 4 %). Conclusion : Endovascular approach can now be considered for all types of carotid stenosis. A cerebral protection with temporary carotid occlusion is mandatory in atherosclerotic carotid bifurcation cases to rule out embolic complication. Complementary stents, when necessary, have reduced the immediate risk of dissection and of restenosis later on.