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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Emergency stenting to treat neurological complications occurring after carotid endarterectomy

Angelo Anzuini, MD^*, Carlo Briguori, MD, PhD^*, Gary S. Roubin, MD, PhD, Salvatore Rosanio, MD, PhD^*, Flavio Airoldi, MD^*, Mauro Carlino, MD^*, Paolo Pagnotta, MD^*, Carlo Di Mario, MD, PhD^*, Imad Sheiban, MD^*, Giuseppe Magnani, MD, Antonio Jannello, MD, Germano Melissano, MD, Roberto Chiesa, MD and Antonio Colombo, MD, FACC^*

^* Interventional Cardiology Unit and Department of Cardiology, IRCCS San Raffaele Hospital, Milan, Italy
Department of Neurology, IRCCS San Raffaele Hospital, Milan, Italy
Department of Vascular Surgery, IRCCS San Raffaele Hospital, Milan, Italy
Interventional Radiology Unit, Lenox Hill Hospital, New York, New York, USA

Manuscript received December 5, 2000; revised manuscript received February 20, 2001, accepted March 1, 2001.

Reprint requests and correspondence: Dr. Antonio Colombo, Interventional Cardiology Unit, San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
segreteria.emodinamica{at}hsr.it

OBJECTIVES

The purpose of this study was to assess the efficacy of emergency stent implantation for the treatment of perioperative stroke after carotid endarterectomy (CEA).

BACKGROUND

Carotid endarterectomy has been proven safe and effective in reducing the risk of stroke in symptomatic and asymptomatic patients with >60% carotid artery stenosis. However, perioperative stroke has been reported in 1.5% to 9% of CEA cases. The management of such a complication is challenging. Recently, percutaneous transluminal carotid angioplasty with stent deployment has emerged as a valuable and alternative strategy for the treatment of carotid artery disease.

METHODS

Between April 1998 and February 2000, 18 of the 995 patients (1.8%) who had CEA in our institution experienced perioperative major or minor neurological complications. Of these, 13 patients underwent emergency carotid angiogram and eventual stent implantation, whereas the remaining five had surgery re-exploration.

RESULTS

Carotid angiogram was performed within 20 ± 10 min and revealed vessel flow-limiting dissection (five cases) or thrombosis (eight cases). Percutaneous transluminal carotid angioplasty with direct stenting (self-expandable stent) was performed in all 13 cases. Angiographic success was 100%. Complete remission of neurological symptoms occurred in 11 of the 13 patients treated by stent implantation and in one of the five patients treated by surgical re-exploration (p = 0.024).

CONCLUSIONS

Stent implantation seems to be a safe and effective strategy in the treatment of perioperative stroke complicating CEA, especially when carotid dissection represents the main anatomic problem.

Abbreviations and Acronyms   CEA = carotid endarterectomy   CI = confidence interval   NIH = National Institutes of Health   PTA = percutaneous transluminal carotid angioplasty   TIA = transient ischemic attack