Recanalization Results after Carotid Stent Placement
Joachim Berkefelda,
Bernd Turowskia,
Andreas Dietzb,
Heinrich Lanfermanna,
Matthias Sitzerb,
Thomas Schmitz-Rixenc,
Helmuth Steinmetzb and
Friedhelm E. Zanellaa
a Institute of Neuroradiology, Johann Wolfgang Goethe-University of Frankfurt am Main, Germany
b Neurology Clinic, Johann Wolfgang Goethe-University of Frankfurt am Main, Germany
c Department of Vascular Surgery, Johann Wolfgang Goethe-University of Frankfurt am Main, Germany
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FIG 1. Suboptimal recanalization results after the placement of a self-expanding Easy Wallstent in the carotid artery. Images demonstrate a lack of apposition between the stent filaments and vessel wall at the bulging of the carotid bulb (arrow).
A, Angiogram shows residual stenosis resulting from stent recoil and gap between stent and arterial wall.
B and C, High-resolution duplex sonogram shows stent recoil after adequate postdilitation of the hyperrchoic plaque and residual flow in the space between stent filaments and vessel wall.
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FIG 2. Geometric effects of a self-expanding carotid Wallstent in a 78-year-old woman with severe generalized atherosclerotic disease.
A, High-grade stenosis close to the origin of the left ICA with calcified plaque material and an elongated tortuous course distal to the stenosis.
B, The stenosis, including the adjacent curve and carotid bifurcation, was covered with the stent, which was implanted with balloon protection. Note the straightening of the treated segment, with associated kinking and moderate stenosis above the distal end of the stent (arrow); the slight concentric vasospasm at the site of the inflated protective balloon (arrowhead);and stent recoiling and malapposition between the stent filaments and carotid bulb (double arrows).
C, The kinking resolved after rotation of the head to the opposite side.
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FIG 3. Follow-up angiograms obtained after stent placement.
A, High-grade stenosis at the origin of the ICA is seen.
B, Implantation of a Wallstent completely restored the vascular lumen. Note the slight narrowing at the origin of the ECA and minimal fusiform dilatation above the distal end of the stent at the site of the protective balloon.
C, After 6 mo, the stent is covered by a smooth layer of neointima, which is prominent within the distal CCA. At the flow divider at the bifurcation, a bulblike bulging is seen. The ECA remained patent. Dilatation at the former site of the protective balloon is no longer visible.
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