Outcomes of angioplasty and stenting at the common carotid origin

Background: Conventional treatment of stenosis at the common carotid artery origin has involved extra-anatomic bypass using an open cervical approach or median sternotomy. The goal of this study is to determine the procedural feasibility and safety of angioplasty and stenting at the common carotid origin as a less invasive alternative. Methods: Between March 1996 and November 2005, a total of 248 carotid angioplasty and/or stenting procedures were performed at our institution. Of these, 8 procedures were performed in 7 patients for treatment of a stenosis or dissection located at the common carotid origin. There were 4 males and 3 females with a mean age of 58 (range, 22-77). Five patients presented with neurologic symptoms. The patients' medical records were retrospectively reviewed for imaging reports (cerebral angiography, computed tomography, or ultrasound) and available clinical follow-up. Brief telephone interviews with patients, immediate family, or care personnel were also used. Procedural and midterm complication rates were calculated. Results: Of 8 procedures, 7 (87.5%) resulted in no residual stenosis. The procedural stroke rate was 0 (0%) of 8 procedures. The procedural TIA rate was 2 (25%) of 8 procedures. The mean follow-up was 31.7 months (range, 11.3-75.9 months). In 2 cases, follow-up was clinical only. In the remaining cases, there were clinical and imaging follow-up in the form of cerebral angiography (n = 3), CT angiography (n = 2), and ultrasound (n = 1). There was one recurrent TIA at 30 days and again at 3.1 months (1/8, 12.5%). There were no strokes (0/8, 0%) and there were no TIAs in patients who were initially asymptomatic on presentation. There was one death from an unrelated cause. Conclusion: In this series, angioplasty and stenting were effective in relieving stenosis at the common carotid origin and have low rates of ischemic complications. (C) 2009 Elsevier Inc. All rights reserved.