Aterosklerotik Ekstrakraniyal İnternal Karotid Arter Preoklüziv Darlıklarında Karotid Stentlemenin Perioperatif Sonuçları

Abstract

Objectives: Carotid artery near-occlusion used to describe the very tight atherosclerotic stenosis in carotid bulb and its main feature is size reduction in artery distal to stenotic ICA (internal carotid artery) segment. The optimal management strategy for carotid artery near occlusion is still controversial. Prior studies about carotid artery stenting (CAS) in patients with near occlusion reported both technically and clinically inspiring results. Nevertheless, perioperative complication related to CAS in patients with near occlusion reported being wide range like %3.3-%17.4. This study aim to evaluate technical success and perioperative complication rate related to CAS in patient with near occlusion. Also, we aim to evaluate is there any difference in complication rate if there is vessel collapse distal to the stenosis. Methods: All extracranial carotid stenosis treated with CAS in Hacettepe University Radiology Department Angiography Unit were retrospectively evaluated. Patients that have extracranial carotid stenosis related to other than atherosclerotic disease are excluded. Among 159 patients that have atherosclerotic carotid stenosis treated with CAS; 55 patients (%34.5) that have carotid near occlusion enrolled to the study. Patient demographics, existing of symptom before CAS procedure, vessel collapse distal to stenosis, angiographic features of the near occlusion, contralateral severe stenosis (>%70), intracranial severe stenosis, use of emboli protective device and its type (proximal, distal, proximal+distal), predilatation before stent deployment, technical success, residual stenosis and perioperative (≤30 day) complication were analyzed. Result: 55 (43 male, 12 women) patients with 56 carotid near occlusion enrolled in the study. One patient had bilateral carotid near occlusion. The mean age of patients was 67.4 (range 46 to 86). 13 patients (%23.2) had near occlusion with collapse and 43 patients (%76.8) had near occlusion without collapse. 38 patients (%67.9) were symptomatic and 18 patients (%32.1) were asymptomatic. 55 of 56 CAS procedure were successful. 3 patients (%25) with near occlusion with collapse and 2 patients (%4.6) with near occlusion without collapse experienced hyperperfusion syndrome (HPS) in perioperative period. Perioperative complications were HPS (%9) and minor stroke (%3.6), when all carotid near occlusion evaluated together. Conclusion: CAS is technically feasible in carotid near occlusion. Nevertheless, carotid near occlusion treatment with CAS is at increased risk of HPS in perioperative period, especially when it performed in patients with carotid near occlusion with collapse.