Intraluminal Palmaz Stent Implantation for Treatment of Recurrent Carotid Artery Occlusive Disease: A Plan for the Future

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Abstract
While carotid endarterectomy (CEA) has been used commonly and with great effectiveness for de novo carotid occlusive lesions, its success in cases of recurrent disease has been attenuated by a higher incidence of complications and lower durability. Although interventional techniques have been introduced cautiously into the cerebrovascular system, balloon dilation for both primary and recurrent carotid atherosclerotic disease has been successful in establishing an adequate lumen without an increase in embolic complications over surgery. Because the likelihood exists that postdilation restenosis may be as common in the carotid arteries as it is in other vascular segments, the use of intraluminal stenting may mitigate this long-term complication, a benefit that has been demonstrated in other high flow vessels such as the aorta and iliac arteries. To begin an investigation of this hypothesis, we treated a 69-year-old symptomatic man who required a third intervention for recurrent carotid disease. A > 90% stenosis of the distal third of his right common carotid artery was successfully dilated, and a Palmaz stent was deployed without incident. The patient experienced no complications to the percutaneous procedure, and at 15 months posttreatment, he is well and asymptomatic. Although greater clinical experience must be accumulated with this new approach, intraluminal stenting following balloon dilation for recurrent carotid disease may surpass redo CEA in long-term patency and may entail fewer procedural complications.