Endovascular Stenting for Carotid Artery Stenosis: Preliminary Experience Using the Shape-memory–Alloy-recoverable–technology (SMART) Stent
Constantine C. Phatourosa,
Randall T. Higashida
,a,
Adel M. Maleka,
Philip M. Meyersa,
Todd E. Lemperta,
Christopher F. Dowda and
Van V. Halbacha
a From the Division of Interventional Neurovascular Radiology, University of California San Francisco Medical Center, San Francisco, CA.
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FIG 1. Anteroposterior views of the left carotid artery bifurcation.
A, Acute dissection involving the proximal internal carotid artery. The true lumen is severely narrowed (arrow), with early pseudoaneurysm formation.
B and C, Position of the first SMART stent, the inferior margin of which projects across the internal carotid artery lumen (small arrow). The long thin arrow indicates where the catheters were temporarily caught in the stent interstices (see Discussion).
D and E, Final appearances after deployment of a second SMART stent, inferiorly and overlapping the first. The second stent crosses the external carotid artery origin, which nonetheless continues to opacify normally.
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FIG 2. Lateral views of the left carotid artery bifurcation.
A, Approximately 70% short-segment, circumferential, atherosclerotic stenosis of the internal carotid artery origin (arrow).
B, Appearances after deployment of a SMART stent, which crosses the origin of the external carotid artery. Note stenosis of the external carotid artery origin as a consequence of stenting across the carotid bifurcation. This is usually of no clinical significance.
FIG 3. Lateral views of the right carotid artery bifurcation.
A, Severe (approximately 90%), long-segment, atherosclerotic stenosis of the common and internal carotid arteries. There is minimal opacification of the external carotid artery (arrow).
B, Appearances after deployment of a SMART stent within the common carotid artery.
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FIG 4. Ipsilateral oblique views of the left carotid artery.
A, Severe short-segment, circumferential, atherosclerotic stenosis of the internal carotid artery origin (arrow).
B, Appearances after deployment of a SMART stent within the internal carotid artery.
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FIG 5. Photograph of the SMART stent shows segmented geometry and flared margins.
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