Clinical Study Of Stent Angioplasty For Extracranial Internal Carotid Artery Stenosis

Objective: To evaluate the clinical application and efficacy of CAS in 67 patients suffering from extracranial internal carotid stenosis in our center.Methods: The clinical data of 67 patients with extracranial carotid stenosis receiving CAS were analyzed retrospectively. The relevant complications were recorded, and postoperative improvements in stenosis, clinical symptoms, NIHSS and MMSE scores were compared with those before operation. The main postoperative neurological complications were recorded during follow-up.Results: 67 patients received CAS under CPD successfully without episodes of stroke and death during the procedure. However, carotid sinus reflex occurred when the stenosis segments were dilated with balloons in 23 cases( 34.3%,23/67) among which hypotension lasted more than 24 hours in 2 cases(3.0%, 2/67). Preoperative stenosis degree, the biggest diameter of balloon and balloon dilatation times are independent risk factors for carotid sinus reflex. Postoperative angiography demonstrated that residual stenosis rate was reduced from(74.6±12.9)% to(12.4±7.7)%(P<0.05). 67 CPDs were withdrawn with macroscopic dropped embolus in 19. Stroke occurred in 2(3.0%, 2/67), hypotension in 2(3.0%, 2/67), mild headache and nausea in 1(1.5%,1/67)and angina in 1(1.5%,1/67) without hyperperfusion syndrome, cerebral hemorrhage and death during hospitalization. Elimination of clinical symptoms were found in 28 patients and 25 patients had residual nervous system dysfunction among patients with symptomatic carotid artery stenosis during follow up for a mean of(14.6±5.9)months, range from 6 months to 29 months. TIAs happened in 5(7.5%,5/67), ipsilateral stroke in 2(3.0%,2/67), angina in 3(4.5%, 3/67)and no death during mean follow up period. 28 patients were followed up by carotid angiography, 22 by CTA and 17 by ultrasonography 6 months after interventional operation, among them, stenosis was confirmed less than 50%. NIHSS score was(1.6±1.3)points and(0.5±0.7)points before operation and in 6 months after therapy respectively. MMSE score was(25.9±2.0)points and(28.1±1.7)points before operation and in 6 months after therapy respectively. The scores of NIHSS and MMSE before and 6 months after operation had statistical significance(P<0.05).Conclusion: The treatment of extracranial internal carotid stenosis by appropriate CAS under EPD according to the clinical manifestation and effective handling of complications can produce a satisfactory therapeutic effects. But a long follow up period is need for continuing evaluation about farther effectives and complications.