Léčení stenóz vnitřní krkavice implantací stentů

Cor Vasa 2002, 43(5):227-232

Managing internal carotid stenoses by stent implantation

Václav Procházka^1,*, Vladimír Čížek¹, Dušan Kučera¹, Karel Dvořák², Jan Rajner³: ¹ Interní oddělení Vítkovické nemocnice blahoslavené Marie Antoníny, a. s.; ² II. interní oddělení - kardiovaskulární; ³ Neurologické oddělení, Městská nemocnice Ostrava, Ostrava, Česká Republika

Aim:
To review the indications and outcome of percutaneous transluminal angioplasty (PTA) with stent implantation in patients with significant internal carotid artery stenoses.

Method:
Patients with the diagnosis of significant internal carotid artery stenoses established by ultrasound had additional assessments by brain panangiography, as well as neurological and other paraclinical examinations performed. Indicated patients had subsequent percutaneous transluminal angioplasty using a self-expandable stent. Starting in mid-2000, the procedure was combined with the use of a protective filter. All patients were monitored by a neurologist during and after the procedure.

Patients and results:
From June 1997 through May 2001, stent implantation was undertaken in 83 patients. Of this number, 69 patients (83%) showed symptoms of a transient ischemic attack (TIA) or stroke while 14 patients (17%) were symptom-free-in these patients, the procedure was performed in preparation to a cardiac surgical or angioplasty surgical procedure. A complication resulting in severe stroke occurred in a single patient (1.2%) whereas a TIA occurred in the vertebrobasilar blood bed region with no stent implantation, and with subsequent full recovery. No complications were seen when using the protective filter.

Conclusion:
Internal carotid PTA with stent implantation is a promising method which, if properly indicated, is not associated with complication rates higher than those reported for surgical endarterectomy. Moreover, it is a method successful also in patients who cannot be managed surgically for a variety of reasons. It should be hoped that further improvements of the instrumentarium, and the routine use of cerebral protection in particular, will further expand the indications for "stenting". Use of new therapeutic procedures, such as combination antiaggregation therapy and the periprocedural administration of IIb/IIIa platelet inhibitors also shows promise.