Percutaneous transluminal angioplasty of the carotid artery: clinical outcome and follow-up

We present our experience with 20 patients in whom percutaneous transluminal angioplasty (PTA) was performed in 23 stenotic carotid arteries. We used an angioplasty technique involving temporary distal balloon occlusion of the internal carotid artery to prevent cerebral embolism during carotid angioplasty. This distal occlusive technique was applied to 10 irregular and ulcerated stenotic lesions. To detect distal embolism related to PTA, magnetic resonance imaging (MRI) was performed in 16 cases (19 lesions) before and after angioplasty. Twenty-one stenotic lesions were successfully dilated. Two lesions were insufficiently dilated. No distal embolism was detected by MRI in 6 cases (9 lesions) with the distally occlusive balloon system. However, new cerebral infarctions possibly related to PTA were detected by MRI in 4 of ten cases (10 lesions) without the distal occlusive balloon system. The infarctions were not associated with any new neurological deficits. During follow-up observation of 1–38 months (average 14 months), 2 patients died of acute myocardial infarction and 4 patients developed restenoses. Three months after PTA, carotid artery stenosis can be treated safely and effectively by PTA. In addition, the distal internal carotid occlusive balloon technique may help prevent PTA-related cerebral embolisation.