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Long-term outcome after angioplasty of symptomatic internal carotid artery stenosis with and without stent

  • Interventional Neuroradiology
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Abstract

Introduction

Carotid angioplasty and stenting (CAS) has widely replaced balloon angioplasty (percutaneous transluminal angioplasty, PTA) in the treatment of internal carotid artery stenosis (ICAS). Here we assess whether the use of stents increases the safety and long-term efficacy of angioplasty in patients with ICAS. Our aim was to test the hypothesis that the long-term efficacy of CAS is superior to that of PTA.

Methods

At the University Medical Center Hamburg-Eppendorf, PTA was performed from 1990 to 1997 and CAS was performed from 1998 to 2006. All patients undergoing these procedures were symptomatic. Selection and follow-up examinations were performed by independent vascular neurologists. Follow-up terms were 1, 3, 6 and 12 months, then annually.

Results

In the PTA group (n = 71), 2.8% of the patients showed severe periinterventional complications (i.e. lasting neurological deficits). Of these 71 patients, 57.7% were followed up for an average period of 51 months. Stenois >70% was observed in 9.8% of the PTA patients, while 4.9% of the patients had ipsilateral occlusions. In the CAS group (n = 354), 4.2% of the patients showed severe periinterventional complications. In total, 61% of the CAS patients were followed up for an average period of 25 months, of whom 4.6% showed stenosis of >70% and 1.9% had ipsilateral occlusions. Periprocedural complications and new symptoms that appeared during follow-up occurred at a rate of 5.6% (PTA) and 5.9% (CAS). There was no difference in the rate of annual ipsilateral events (1.1% in PTA vs. 1.3% in CAS, p = 1.000)

Conclusion

Overall, the use of stents, rather than PTA only, shows no beneficial clinical effect in the treatment of ICA stenosis. While the rate of restenosis may be significantly reduced, this merely suggests that the impact of restenosis is less apparent than expected.

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Acknowledgment

We thank Christian Koops of Rice University, Houston, Texas, for his linguistic advice.

Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Gebäuder W14, Hamburg, 20246, Germany

    O. Wittkugel, J. Fiehler, H. Zeumer & U. Grzyska

  2. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    J. Gbadamosi & M. Rosenkranz

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  1. O. Wittkugel
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Correspondence to O. Wittkugel.

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Wittkugel, O., Gbadamosi, J., Rosenkranz, M. et al. Long-term outcome after angioplasty of symptomatic internal carotid artery stenosis with and without stent. Neuroradiology 50, 243–249 (2008). https://doi.org/10.1007/s00234-007-0326-x

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  • DOI: https://doi.org/10.1007/s00234-007-0326-x

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