Stenting for cervical carotid artery stenosis: Preliminary experience

We report excellent initial results of stenting for cervical carotid artery stenosis. Patients demonstrated three lesions that met the criteria used by the studies of the North American Symptomatic Carotid Endarterectomy Trial Collaborators (NASCET) or the Committee for the A-symptomatic Carotid Atherosclerosis Study (A-CA-S) for carotid endarterectomy (CEA). Stenting was performed for restenosis after CEA in one patient, and as an initial treatment in two patients. Stents utilized in these patients were Palmaz stents, the balloon expandable type originally developed for peripheral arteries. Stents were placed at the lesion after predilatation in one patient and primarily in two patients. Additional protective balloon catheter was employed in one patient. Complete dilatation was obtained in every patient without any adverse event. Several techniques are needed, particularly in postdilatation, to fit stent to arterial wall and to obtain a smooth vascular lumen in cervical carotid artery where the diameter changes naturally from proximal to distal portion. Further considerations of the necessity of protective balloon and degree of perioperative anticoagulation therapy will require more experience. Usefulness of stenting for cervical carotid artery stenosis was indicated by our initial results, but the development of a better stent for the cervical carotid artery and long-term follow-up are mandatory.