Carotid endarterectomy performed after progressive carotid stenosis following angioplasty and stent placement

Case report

Fernando L. ValeDivisions of Neurosurgery and Neuropathology, University of Alabama at Birmingham, Birmingham, Alabama

Search for other papers by Fernando L. Vale in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Winfield S. Fisher IIIDivisions of Neurosurgery and Neuropathology, University of Alabama at Birmingham, Birmingham, Alabama

Search for other papers by Winfield S. Fisher III in
Current site
Google Scholar
PubMed
Close
 M.D.
,
William D. Jordan Jr.Divisions of Neurosurgery and Neuropathology, University of Alabama at Birmingham, Birmingham, Alabama

Search for other papers by William D. Jordan Jr. in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Cheryl A. PalmerDivisions of Neurosurgery and Neuropathology, University of Alabama at Birmingham, Birmingham, Alabama

Search for other papers by Cheryl A. Palmer in
Current site
Google Scholar
PubMed
Close
 M.D.
, and
Jiri VitekDivisions of Neurosurgery and Neuropathology, University of Alabama at Birmingham, Birmingham, Alabama

Search for other papers by Jiri Vitek in
Current site
Google Scholar
PubMed
Close
 M.D.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

✓ Carotid endarterectomy (CEA) is the treatment of choice for asymptomatic and symptomatic disease causing greater than 60% internal carotid artery (ICA) stenosis. Recently, percutaneous transluminal angioplasty (PTA) with stent placement has been investigated as a therapeutic option for the treatment of ICA stenosis. In this report the authors document CEA performed after PTA with stent placement and describe the pathological findings.

A standard CEA was performed. The surgical intervention was more difficult secondary to the following variables: the length of the exposure necessary to dissect out the metallic stent, the difficulty with opening and cutting the artery, and the care required to remove the stent to avoid vessel wall perforation. Pathological examination of the specimen demonstrated classic atherosclerotic changes revealing persistence of native disease. The metallic stent was embedded within the plaque. Many questions remain unanswered regarding the physiological and biological changes that occur in the carotid vessel wall after PTA with stent placement. It is concluded that CEA of a stent-containing carotid artery is feasible and should be considered as an alternative when recurrent stenosis occurs after PTA.

  • Collapse
  • Expand
  • 1.

    Bockenheimer SA, & Mathias K: Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis. AJNR 4:791792, 1983 Bockenheimer SA, Mathias K: Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis. AJNR 4:791–792, 1983

    • Search Google Scholar
    • Export Citation
  • 2.

    Das MB, , Hertzer NR, & Ratliff NB, et al: Recurrent carotid stenosis. A five-year series of 65 reoperations. Ann Surg 202:2835, 1985 Das MB, Hertzer NR, Ratliff NB, et al: Recurrent carotid stenosis. A five-year series of 65 reoperations. Ann Surg 202:28–35, 1985

    • Search Google Scholar
    • Export Citation
  • 3.

    Dempsey RJ, , Moore RW, & Cordero S: Factors leading to early recurrence of carotid plaque after carotid endarterectomy. Surg Neurol 43:278283, 1995 Dempsey RJ, Moore RW, Cordero S: Factors leading to early recurrence of carotid plaque after carotid endarterectomy. Surg Neurol 43:278–283, 1995

    • Search Google Scholar
    • Export Citation
  • 4.

    Ellis SG, , Savage M, & Fischman D, et al: Restenosis after placement of Palmaz-Schatz stents in native coronary arteries. Initial results of a multicenter experience. Circulation 86:18361844, 1992 Ellis SG, Savage M, Fischman D, et al: Restenosis after placement of Palmaz-Schatz stents in native coronary arteries. Initial results of a multicenter experience. Circulation 86:1836–1844, 1992

    • Search Google Scholar
    • Export Citation
  • 5.

    Executive Committee for the Asymptomatic Carotid Atherosclerosis Study: endarterectomy for asymptomatic carotid artery stenosis. JAMA 273:14211428, 1983 Executive Committee for the Asymptomatic Carotid Atherosclerosis Study: endarterectomy for asymptomatic carotid artery stenosis. JAMA 273:1421–1428, 1983

    • Search Google Scholar
    • Export Citation
  • 6.

    Foley JB, , Brown RIG, & Penn IM: Thrombosis and restenosis after stenting in failed angioplasty: comparison with elective stenting. Am Heart J 128:1220, 1994 Foley JB, Brown RIG, Penn IM: Thrombosis and restenosis after stenting in failed angioplasty: comparison with elective stenting. Am Heart J 128:12–20, 1994

    • Search Google Scholar
    • Export Citation
  • 7.

    Gersak B, & Gabrijelcic T: Successful surgical removal of partially expanded Palmaz stent from external iliac artery. Panminerva Medica 37:9294, 1995 Gersak B, Gabrijelcic T: Successful surgical removal of partially expanded Palmaz stent from external iliac artery. Panminerva Medica 37:92–94, 1995

    • Search Google Scholar
    • Export Citation
  • 8.

    Marks MP, , Dake MD, & Steinberg GK, et al: Stent placement for arterial and venous cerebrovascular disease: preliminary experience. Radiology 191:441446, 1994 Marks MP, Dake MD, Steinberg GK, et al: Stent placement for arterial and venous cerebrovascular disease: preliminary experience. Radiology 191:441–446, 1994

    • Search Google Scholar
    • Export Citation
  • 9.

    North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445453, 1991 North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453, 1991

    • Search Google Scholar
    • Export Citation
  • 10.

    Parsson H, , Cwikiel W, & Johansson K, et al: Deposition of platelets and neutrophils in porcine iliac arteries after angioplasty and Wallstent placement compared with angioplasty alone. Cardiovasc Intervent Radiol 17:190196, 1994 Parsson H, Cwikiel W, Johansson K, et al: Deposition of platelets and neutrophils in porcine iliac arteries after angioplasty and Wallstent placement compared with angioplasty alone. Cardiovasc Intervent Radiol 17:190–196, 1994

    • Search Google Scholar
    • Export Citation
  • 11.

    Ross JF, , Deck JH, & Gotlieb AI: Pathology of atherosclerotic plaques, in Smith RR (ed): Stroke and the Extracranial Vessels. New York: Raven Press, 1984, pp 2327 Ross JF, Deck JH, Gotlieb AI: Pathology of atherosclerotic plaques, in Smith RR (ed): Stroke and the Extracranial Vessels. New York: Raven Press, 1984, pp 23–27

    • Search Google Scholar
    • Export Citation
  • 12.

    Salam TA, , Taylor B, & Suggs WD, et al: Reaction to injury following balloon angioplasty and intravascular stent placement in the canine femoral artery. Am Surg 60:353357, 1994 Salam TA, Taylor B, Suggs WD, et al: Reaction to injury following balloon angioplasty and intravascular stent placement in the canine femoral artery. Am Surg 60:353–357, 1994

    • Search Google Scholar
    • Export Citation
  • 13.

    Sapoval MR, , Long AL, & Raynaud AC, et al: Femoropopliteal stent placement: long-term results. Radiology 184:833889, 1992 Sapoval MR, Long AL, Raynaud AC, et al: Femoropopliteal stent placement: long-term results. Radiology 184:833–889, 1992

    • Search Google Scholar
    • Export Citation
  • 14.

    Shawl FA, , Efstratiou A, & Hoff S, et al: Combined percutaneous carotid stenting and coronary angioplasty during acute ischemic neurologic and coronary syndromes. Am J Cardiol 77:11091112, 1996 Shawl FA, Efstratiou A, Hoff S, et al: Combined percutaneous carotid stenting and coronary angioplasty during acute ischemic neurologic and coronary syndromes. Am J Cardiol 77:1109–1112, 1996

    • Search Google Scholar
    • Export Citation
  • 15.

    Strauss BH, , Umans VA, & van Suylen RJ, et al: Directional atherectomy for treatment of restenosis within coronary stents: clinical, angiographic, and histologic results. J Am Coll Cardiol 20:14651473, 1992 Strauss BH, Umans VA, van Suylen RJ, et al: Directional atherectomy for treatment of restenosis within coronary stents: clinical, angiographic, and histologic results. J Am Coll Cardiol 20:1465–1473, 1992

    • Search Google Scholar
    • Export Citation
  • 16.

    White GH, , Liew SCC, & Waugh RC, et al: Early outcome and intermediate follow-up of vascular stents in the femoral and popliteal arteries without long-term anticoagulation. J Vasc Surg 21:270281, 1995 White GH, Liew SCC, Waugh RC, et al: Early outcome and intermediate follow-up of vascular stents in the femoral and popliteal arteries without long-term anticoagulation. J Vasc Surg 21:270–281, 1995

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 358 53 8
Full Text Views 182 2 0
PDF Downloads 57 2 0
EPUB Downloads 0 0 0