ANGIOPLASTY AND STENTING OF CAROTID ARTERIES IN PATIENTS WITH HIGH SURGICAL RISK

Ignatiev I.M., Volodyukhin M.Yu., Malinovskii M.N.
Federal Facility Interregional Clinical-and-Diagnostic Centre,
Kazan, Russia

The authors carried out carotid angioplasty and stenting (CAS) in forty-six patients (with a total of 48 interventions performed). Of these, forty-two (91.3%) patients were found to belong to a high-surgical-risk group. The patients years (mean age – 62.1±8.2 years). Thirty-six patients were found to have symptomatic lesions of the internal carotid arteries (ICAs) >70%, and ten had asymptomatic stenoses >80%. Twenty-three (50%) patients were diagnosed with grade II cerebrovascular insufficiency (CVI) (transitory ischaemic attacks). Amongst the most frequently encountered accompanying pathologies were various-severity CADs in forty (95.2%) patients, and arterial hypertension in thirty-eight (90.4%). The cerebral blood flow state during CAS interventions was controlled by means of transcranial Doppler ultrasonography in sixteen patients.

In twelve patients, the main stage of the intervention was performed under control of ultrasonographic duplex scanning (USDS). The technical success of the operation was achieved in forty-four (95.7%) cases. Failures were primarily caused by impossibility of passing the guidewire catheter in type 3 aortic arch in two patients. Twenty-six (56.5%) patients developed bradycardia and hypotension after CAS. No haemodynamically significant restenoses following CAS within the follow-up terms from 2 to 12 months were observed in twenty-two patients.

The article also contains a brief comparative analysis of multicenter randomized studies on the CAS-related problem. In conclusion, the authors note safety and high efficiency of CAS, considering this intervention an alternative to carotid endarterectomy in patients with elevated surgical risk. A USDS-controlled operation significantly broadens the possibilities of the method concerned.

KEY WORDS: carotid angioplasty, stenting, patients with high surgical risk, ultrasonographic duplex scanning, randomized study.

P. 89

« Back