Efficacy of Treatment of Severe Carotid Bifurcation Stenosis By Using Self-Expanding Stents without Deliberate Use of Angioplasty Balloons
Stephen P. Lowniea,b,
David M. Pelza,
Donald H. Leea,
Suleyman Mena,
Irene Gulkaa and
Paul Kalaposa
a Department of Diagnostic Radiology, Division of Neurosurgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
b Department of Clinical Neurological Sciences, Division of Neuroradiology Division of Neurosurgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
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FIG 1. A, Right CCA digital subtraction arteriogram (DSA), lateral view, showing a very severe atherosclerotic stenosis of the proximal ICA, >95% by NASCET criteria (arrow).
B, Repeat DSA, lateral view, immediately poststenting alone, without balloon angioplasty, showing a reduction in the degree of stenosis to approximately 29%.
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FIG 2. A, Left CCA DSA, AP view, showing a severe stenosis of the proximal ICA, measuring approximately 76% (arrow).
B, Repeat DSA, AP view, immediately poststenting without balloon angioplasty, showing reduction of the stenosis to approximately 50% (arrow).
C, Follow-up DSA, AP view, 3 years poststenting alone, shows no residual ICA stenosis.
D, E, and F, Conventional AP radiographs of the neck immediately poststenting (D), 1 month (E) and 8 months (F) poststenting, showing progressive opening of the stent waist (arrow), with maximum expansion occurring in the 1st month postprocedure.
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FIG 3. Follow-up radiologic results based on initial angiography and subsequently conventional radiographs of the stented artery. Degree of stenosis measured according to NASCET method.
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FIG 4. Follow-up sonography results based on peak systolic velocity measurements, Matched pairs of measurements in the same patients at different time intervals after stent placement.
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FIG 5. Follow-up sonography results based on ratio of ICA to common carotid velocity. Matched pairs of measurements in the same patients at different time intervals after stent placement.
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FIG 6. A, Right lateral CCA DSA, showing a severe stenosis of the proximal ICA, measuring approximately 80%.
B, Repeat lateral DSA, poststenting alone, showing reduction of the stenosis to approximately 63%.
C, D, and E, Conventional AP radiographs of the neck immediately poststenting (C), 5 months (D), and 8 months (E) poststenting. There has been no further expansion of the stent over 8 months. Note the prominent, focal plaque calcification (arrows).
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FIG 7. Table showing breakdown of results according to the degree of immediate or delayed expansion of the self-expanding stent. Percentage results are according to the NASCET criteria, based on the widest luminal diameter of the metallic stent beyond point of maximum stenosis.
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