CardioVascular and Interventional Radiology

, Volume 30, Issue 5, pp 854–860 | Cite as

Exclusion of Atherosclerotic Plaque from the Circulation Using Stent-Grafts: Alternative to Carotid Stenting with a Protection Device?

  • Bora Peynircioglu
  • Serdar Geyik
  • Kivilcim Yavuz
  • Barbaros E. Cil
  • Isil Saatci
  • Saruhan Cekirge
Clinical Investigation



To retrospectively assess the feasibility, safety, and clinical mid-term outcome of patients undergoing carotid artery stenting with stent-grafts.


Over a 4 year period stent-grafts were used in the endovascular treatment of symptomatic internal carotid artery stenosis in 12 patients (2 women, 10 men, aged 47–83 (mean 64) years). Protection devices were not used. Possible microembolic complications were evaluated by magnetic resonance imaging (MRI) examinations of the brain before and the day after the procedure in all patients. Mean follow-up was 22 months (range 1–42 months), by Doppler ultrasonography and conventional angiography as well as clinical examination.


The technical success rate was 100%. A total of 13 coronary stent-grafts were used. The mean stenosis rate (in terms of diameter) was 85% and the mean length of stent-grafts used was 20.9 mm. The mean diameter to which the stent-grafts were dilated was 4.66 mm. In-hospital complications occurred in 1 patient who suffered a minor femoral access hematoma that did not require transfusion or surgical decompression. Post-stenting diffusion-weighted MRI revealed several ipsilateral silent microemboli in only 1 case, which was completely asymptomatic. Two patients had a major stroke after 2 years of follow-up. Restenosis was found in 2 patients who underwent successful balloon dilatation followed by placement of a self-expandable bare stent within the stent-grafts.


Stent-grafts may prevent microembolic complications during stenting of atherosclerotic carotid lesions in selected cases, offering immediate exclusion of the atherosclerotic lesion from the circulation by pressing the plaque against the vessel wall. Comparative, randomized studies in larger series of patients are needed with carotid-dedicated stent-graft designs.


Atherosclerotic stenosis Carotid artery stenting Stent-grafts 


  1. 1.
    Cavatas (2001) Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study: A randomised trial. Lancet 357:1729–1737Google Scholar
  2. 2.
    Coward LJ, Featherstone RL, Brown MM (2005) Safety and efficacy of endovascular treatment of carotid artery stenosis compared with carotid endarterectomy: A Cochrane systematic review of the randomized evidence. Stroke 36:905–911PubMedCrossRefGoogle Scholar
  3. 3.
    Theiss W, Hermanek P, Mathias K, Ahmadi R, Heuser L, Hoffmann FJ, et al. (2004) Pro-CAS: A prospective registry of carotid angioplasty and stenting. Stroke 35:2134–2139PubMedCrossRefGoogle Scholar
  4. 4.
    Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al. (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501PubMedCrossRefGoogle Scholar
  5. 5.
    Fayad P (2004) SAPPHIRE: Stenting and angioplasty with protection in patients at high risk for endarterectomy: The Sapphire study. The 2 year follow-up results. Fifth World Stroke Congress, Vancouver, Canada, June 23–26Google Scholar
  6. 6.
    Angelini A, Reimers B, Barbera MD, et al. (2002) Cerebral protection during carotid artery stenting: Collection and histopathologic analysis of embolized debris. Stroke 33:456–461PubMedCrossRefGoogle Scholar
  7. 7.
    Theron JG, Payelle GG, Coskun O, Huet HF, Guimaraens L (1996) Carotid artery stenosis with protected balloon angioplasty and stent placement. Radiology 201:627–636PubMedGoogle Scholar
  8. 8.
    Fanelli F, Bezzi M, Boatta E, Passariello R (2006) Techniques in cerebral protection. Eur J Radiol 60:26–36. Epub July 26, 2006PubMedCrossRefGoogle Scholar
  9. 9.
    Terada T, Tsuura M, Matsumoto H, et al. (2003) Results of endovascular treatment of internal carotid artery stenoses with a newly developed balloon protection catheter. Neurosurgery 53:617–623PubMedCrossRefGoogle Scholar
  10. 10.
    Theron J, Guimaraens L, Coskun O, Sola T, Martin JB, Rufenacht DA (1998) Complications of carotid angioplasty and stenting. Neurosurg Focus 5:1–19CrossRefGoogle Scholar
  11. 11.
    Müller-Hülsbeck S, Stolzmann P, Liess C, Hedderich J, Paulsen F, Jahnke T, et al. (2005) Vessel wall damage caused by cerebral protection devices: Ex vivo evaluation in porcine carotid arteries. Radiology 235:454–460PubMedCrossRefGoogle Scholar
  12. 12.
    Sovik E, Klow NE, Brekke M, Stavnes S (2003) Elective placement of covered stents in native coronary arteries. Acta Radiol 44:294–301PubMedCrossRefGoogle Scholar
  13. 13.
    Elsner M, Auch-Schwelk W, Britten M, Walter DH, Schachinger V, Zeiher AM (1999) Coronary stents grafts covered by a polytetrafluoroethylene membrane. Am J Cardiol 84:335–338PubMedCrossRefGoogle Scholar
  14. 14.
    Layton KF, Kim YW, Hise JH (2004) Use of covered stent-grafts in the extracranial carotid artery: Report of three patients with follow-up between 8 and 42 months. AJNR Am J Neuroradiol 25:1760–1763PubMedGoogle Scholar
  15. 15.
    Saket RR, Razavi MK, Sze DY, Frisoli JK, Kee ST, Dake MD (2004) Stent-graft treatment of extracranial carotid and vertebral arterial lesions. J Vasc Interv Radiol 15:1151–1156PubMedGoogle Scholar
  16. 16.
    Saatci I, Cekirge HS, Ozturk MH, Arat A, Ergungor F, Sekerci Z, et al. (2004) Treatment of internal carotid artery aneurysms with a covered stent: Experience in 24 patients with mid-term follow-up results. AJNR Am J Neuroradiol 25:1742–1749PubMedGoogle Scholar
  17. 17.
    Cil BE, Akpinar E, Peynircioglu B, Cekirge S (2004) Utility of covered stents for extracranial internal carotid artery stenosis. AJNR Am J Neuroradiol 25:1168–1171PubMedGoogle Scholar
  18. 18.
    North American Symptomatic Carotid Endarterectomy Trial (1991) Methods, patient characteristics, and progress. Stroke 22:711–720Google Scholar
  19. 19.
    Chaturvedi S, Yadav JS (2006) The role of antiplatelet therapy in carotid stenting for ischemic stroke prevention. Stroke 37:1572–1577PubMedCrossRefGoogle Scholar
  20. 20.
    Hauth EA, Drescher R, Jansen C, Gissler HM, Schwarz M, Forsting M, et al. (2006) Complications and follow-up after unprotected carotid artery stenting. Cardiovasc Intervent Radiol 29:511–518PubMedCrossRefGoogle Scholar
  21. 21.
    Bosiers M, Peeters P, Deloose K, et al. (2005) Does carotid artery stenting work on the long run? 5-year results in high-volume centers (ELOCAS Registry). J Cardiovasc Surg (Torino) 46:241–247Google Scholar
  22. 22.
    Vos AW, Linsen MA, Marcus JT, van den Berg JC, Vos JA, Rauwerda JA, Wisselink W (2003) Carotid artery dynamics during head movements: A reason for concern with regard to carotid stenting? J Endovasc Ther 10:862–869PubMedCrossRefGoogle Scholar
  23. 23.
    Wholey MH, Wholey MH, Tan WA, Eles G, Jarmolowski C, Cho S (2003) A comparison of balloon-mounted and self-expanding stents in the carotid arteries: Immediate and long-term results of more than 500 patients. J Endovasc Ther 10:171–181PubMedCrossRefGoogle Scholar
  24. 24.
    Mathur A, Dorros G, Iyer SS, et al. (1997) Palmaz stent compression in patients following carotid artery stenting. Cathet Cardiovasc Diagn 41:137–140PubMedCrossRefGoogle Scholar
  25. 25.
    Palmaz JC, Richter GM, Noeldge G, Schatz RA, Robison PD, Gardiner GA Jr, et al. (1988) Intraluminal stents in atherosclerotic iliac artery stenosis: Preliminary report of a multicenter study. Radiology 168:727–731PubMedGoogle Scholar
  26. 26.
    Burger DH, Kappetein AP, Van Bockel JH, Breslau PJ (2000) A prospective randomized trial comparing vein with polytetrafluoroethylene in above-knee femoropopliteal bypass grafting. J Vasc Surg 32:278–283PubMedCrossRefGoogle Scholar
  27. 27.
    Müller-Hülsbeck S, Jahnke T, Stolzmann P, Paulsen F, Wenke R, Heller M (2003) A new concept for covered stent protected carotid angioplasty: An ex vivo study. Rofo 175:1634–1638PubMedGoogle Scholar
  28. 28.
    Greil O, Kleinschmidt T, Weiss W, Wolf O, Heider P, Schaffner S, et al. (2005) Flow velocities after carotid artery stenting: Impact of stent design. A fluid dynamics study in a carotid artery model with laser Doppler anemometry. Cardiovasc Intervent Radiol 28:66–76PubMedCrossRefGoogle Scholar
  29. 29.
    Lin PH, Zhou W, Guerrero MA, McCoy SA, Felkai D, Kougias P, et al. (2006) Carotid artery stenting with distal protection using the carotid Wallstent and filterwire neuroprotection: Single-center experience of 380 cases with midterm outcomes. Vascular 14:237–244PubMedCrossRefGoogle Scholar
  30. 30.
    Schillinger M, Dick P, Wiest G, et al. (2006) Covered versus bare self-expanding stents for endovascular treatment of carotid artery stenosis: A stopped randomized trial. J Endovasc Ther 13:312–319PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Bora Peynircioglu
    • 1
    • 2
  • Serdar Geyik
    • 1
  • Kivilcim Yavuz
    • 1
  • Barbaros E. Cil
    • 1
  • Isil Saatci
    • 1
  • Saruhan Cekirge
    • 1
  1. 1.Department of RadiologyHacettepe University, School of MedicineAnkaraTurkey
  2. 2.Department of RadiologyHacettepe University, School of MedicineGOP-AnkaraTurkey

Personalised recommendations