Article Figures & Data
Figures
- Fig 1.
A case of long-term stent patency in patient 4, a 68-year-old woman with thyroidectomy for carcinoma followed by postoperative radiation, bilateral radical neck dissection, and permanent tracheostomy, who experienced transient ischemic changes in the left cerebral hemisphere 21 years after radiation therapy. The patient had a history of graft placement between her left CCA and left subclavian arteries (5 years before admission) as well as a right CCA vein graft bypass (10 years before admission).
A, Digital subtraction angiography (DSA) reveals a 70% stenosis (arrow) of the distal left CCA. Note the bypass graft (arrowhead) between the left CCA and left subclavian arteries.
B, Successful stent placement with little residual stenosis. The proximal end of the 8 × 40 mm Wallstent (Boston Scientific, Natick, MA) extends across the origin of the left subclavian graft (arrow). Poststent angioplasty with an 8 × 40 mm Olbert balloon (Boston Scientific) resulted in rupture of the balloon.
C, Repeat DSA 4.5 years after stent placement shows a patent carotid artery with interval auto expansion of the stent.
- Fig 2.
A case of multiple restenting in patient 2, a 61-year-old man with bilateral radical neck dissection and external beam radiation for laryngeal cancer 15 years before right cerebral hemisphere stroke due to right ICA occlusion.
A, DSA shows an 85% ulcerated stenosis (arrow) of the proximal left ICA.
B, DSA after angioplasty and stent placement shows little residual stenosis. Prestent angioplasty was performed with a 4 × 20 mm Symmetry balloon (Boston Scientific). This was followed by placement of an 8 × 40 mm Wallstent (Boston Scientific). Poststent angioplasty was performed by using an 8 × 40 mm Olbert balloon (Boston Scientific).
C, Repeat DSA 5 years after stent placement shows 70% restenosis (arrow) in the distal left CCA at the inferior margin of the stent. The external carotid artery no longer fills.
D, DSA after angioplasty and stent placement with a 5 × 20 mm Savvy balloon (Cordis Corp., Miami Lakes, FL) followed by a 7 × 20 mm Precise stent (Cordis). There is minimal filling of the external carotid artery.
E, DSA 17 months later shows a focal high-grade in-stent restenosis (arrow) and a less severe stenosis in the CCA (arrowhead).
F, Immediate DSA following placement of a third stent (7 × 40 mm Precise; Cordis) and poststent angioplasty with a 6 × 40 Savvy balloon (Cordis) shows a good angiographic result.
Tables
Pt Age/Sex Malignancy Interval (years) Neurological Symptoms Radical Neck Dissection Prior CEA (months before stenting) Other Vessel Occlusions* 1 62/F Parotid 3 TIA Yes No LICA 2 61/M Laryngeal 15 Stroke Yes No RICA, R vert 3 57/M Pituitary 22 TIA No Bilateral (2) 4 68/F Thyroid 21 TIA Yes No 5 66/M Head and neck 17 TIA Yes No 6 68/M Oral 1 None Yes Contralateral (13) 7 77/M Laryngeal 5 TIA Yes No 8 76/F Glomus tumor 1 None No Bilateral (60) L vert 9 68/M Oral 12 TIA No No 10 68/M Lymphoma 3 Stroke No No 11 56/M Tonsilar 4 TIA Yes No 12 56/M Head and neck 2 TIA Yes No 13 54/F Lymphoma 23 None No No 14 52/M Laryngeal 1 Syncope Yes No R vert 15 73/M Head and neck 7 TIA Yes No L vert 16 79/F Head and neck 3–13 None Yes Contralateral (83) Note.—Pt indicates patient; Interval, time from radiation therapy to neurological symptoms; CEA, carotid endarterectomy; TIA, transient ischemic attack; R, right; L, left; ICA, internal carotid artery; vert, vertebral artery.
* Untreated.
Pt Vessel Stenosis (%) Stent Size (mm) Across Bifurcation Prestent Angiography Poststent Angiography F/u (mo) Neurological Symptoms after Stenting Imaging Outcome 1 RICA 75 Wallstent 8 × 20 No Yes Yes None 2 LICA 85 Wallstent 8 × 40 Yes Yes Yes 61 TIA Restented 70 Precise 7 × 20 No, LCCA Yes No 17 No Restented 75 Precise 7 × 40 No, LCCA No Yes 3 RCCA 90 Wallstent 10 × 42 No Yes Yes 76 No Patent 4 LCCA 70 Wallstent 8 × 40 No No Yes 55 No Patent 5 LICA 80 Wallstent 10 × 40 No Yes Yes 13 No Restented 70 Wallstent 6 × 20 No Yes Yes 50 No Patent RICA 99 Smart 8 × 40 No Yes Yes 22 No Occluded 6 RICA 75 Wallstent 6 × 20 Yes Yes Yes 22 No Patent 7 LCCA 70 NIR 4 × 18 No No Yes 14 Stroke* Occluded 8 RICA 95 Smart 6 × 60 Yes Yes Yes 34 No Patent 9 LICA 80 Smart 10 × 20 No Yes No 32 No Patent 10 LICA 75 Smart 10 × 20 No Yes Yes 11 No Patent RICA 95 Smart 6 × 20 No Yes No 7 No Patent 11 RICA 95 Smart 9 × 30 No Yes Yes 9 No Patent LICA 85 Smart 10 × 40 No Yes No 8 No Patent 12 LICA 99 Smart 9 × 40 No Yes No 16 No Reangioplasty 13 RICA 90 Smart 9 × 30 Yes Yes No 11 No Patent 14 LCCA 90 Precise 8 × 30 No Yes No None 15 LCCA 95 Precise, × 2 6 × 40, 6 × 20 No Yes No 12 No Patent 16 LICA 80 Precise 8 × 20 No Yes No 5 No Patent Note.—Pt indicates patient; F/u, follow-up; R, right; L, left; ICA, internal carotid artery; CCA, common carotid artery; TIA, transient ischemic attack. Wallstent, NIR (Boston Scientific Corp., Natick, MA); Smart, Precise (Cordis Corp., Miami Lakes, FL).
* Stroke occurred shortly after patient developed atrial fibrillation.
Total procedures 23 22 angioplasty and stenting 1 angioplasty Procedural stroke rate 1/23 (4%) Procedural TIA rate 0/23 (0%) 30-day stroke/TIA rate 0/23 (0%) Total vessels stented 19 Vessels remaining patent 15/19 (79%) 2 repeat angioplasty and stenting 1 restenosis at distal stent margin 1 at proximal stent margin (a third procedure was done for proximal stent margin stenosis with concurrent in-stent stenosis) 1 repeat angioplasty (without stent placement) restenosis at distal stent margin Vessels occluded 2/19 (11%) Vessels lost to follow-up 2/19 (11%) Note.—TIA indicates transient ischemic attack.
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