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Endovascular Repair of Tandem Carotid Stenoses

Thursday, 22 September, 2011 - 12:00
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Endovascular Repair of Tandem Carotid Stenoses

 

Hélène Loubière (1), Hubert Desal (2), Laure Azéma (1), Alain Costargent (1), Philippe Chaillou (1), Philippe Patra (1), Yann Gouëffic (1)

 

(1) Department of vascular surgery, Institut du thorax, University hospital of Nantes, 44000 Nantes, France

(2) Department of neuroradiology, University hospital of Nantes, 44000 Nantes, France

BACKGROUND AND PURPOSE:

Tandem carotid stenoses combines simultaneous stenoses at the origin of the extracranial internal carotid (EIC) and intracranial internal carotid (IIC). We present 4 cases of patients treated with endovascular repair for tandem carotid stenoses.

METHODS:

Each case was discussed by a multidisciplinary team including vascular surgeons, neurologists and neuro-radiologists. Interventions were performed under general anesthesia in the neuroangiography laboratory. Patients were prescribed clopidogrel (75-mg/d) and aspirin (160-mg/d) 1 week before the intervention. Heparin (50UI/kg) was given during the procedure. First, IEC stenosis was treated by primary self expandable stenting without cerebral protection. Then IIC stenosis was treated either by a self expandable stent or a balloon expandable stent. Technical success for EIC and IIC stenoses was defined by residual stenosis at 30% and 50% respectively. Follow-up included physical examination and duplex scan at 1, 6, 12 months and yearly, and CT scan at 6 and 12months.

RESULTS:

Patient 1 (48 year-old) who presented transient right hemiparesia had 70% stenosis of the left EIC and ipsilateral pre-occlusive IIC stenosis. Patient 2 (57 year-old) was asymptomatic and had 70% stenosis of the right EIC and the right IIC, and occlusion of the left siphon. Patient 3 (64 year-old) presented 70% stenosis of the right EIC and 70% stenosis of the ipsilateral IIC. Patient 4 (78 year-old) who presented transient right hemiparesia had 90% stenosis of the left EIC and 50% stenosis of the ispislateral IIC. Technical success rate was 100%. No death or stroke were reported during the perioperative period. Mean hospital length of stay was 4.75 days. No clinical event was reported during the follow-up (mean: 24.5 months). Duplex scan and CT did not reveal thrombosis or in-stent restenosis.

CONCLUSION:

In these cases, endovascular treatment of tandem carotid stenoses was safe and effective. These results should be confirmed by a larger study.

 

Part of Session

Vascular Surgery

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