The Endovascular Treatment of Carotid and Vertebral Artery Atherosclerotic Disease
The treatment of arterial stenosis by endovascular techniques has the attraction of avoiding open surgery and general anaesthesia which are required for endarterec-tomy or bypass surgery. Percutaneous transluminal angioplasty (PTA) is frequently performed and is often the first line procedure for stenosis of the peripheral and coronary vessel. There has been reluctance to recommend PTA for the cerebral circulation because of the anxiety about the risks of cerebral embolism (Health and Public Policy Committee, 1983). However, evidence is accumulating that the risks of PTA in the proximal internal carotid and vertebral arteries are no greater than those of PTA at other sites and are similar to the risks of carotid surgery. Clinical trials are now underway assess the procedure and to compare it with carotid endarterectomy, in particular the Carotid Vertebral Artery Transluminal Angioplasty Study. It is possible that if these confirm the safety and efficacy of cerebral vascular PTA, the procedure will become the preferred alternative to surgery in suitable patients. Cerebral vascular PTA also provides a valuable option in experienced centres for the treatment of patients with surgically inaccessible vertebral carotid artery stenosis or for patients who are not fit for surgery.
KeywordsVertebral Artery Carotid Endarterectomy Carotid Stenosis Asymptomatic Carotid Internal Carotid Artery Stenosis
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- Ferguson RDG, The North American Cerebral Percutaneous Transluminal Angioplasty Register (NACPTAR) investigators (1995) Vascular determinants of successful cerebral percutaneous transluminal angioplasty (CPTA). Neurology 45 (supplement 4): A375 (abstract)Google Scholar
- Health and Public Policy Committee American College of Physicians (1983) Percutaneous transluminal angioplasty. Ann Int Medi 99: 864–869Google Scholar
- Hebrang A, Maskovic J, Tomac B (1994) Percutaneous transluminal angioplasty of the subclavian arteries: long-term results in 52 patients. AJR 156: 1091–1094Google Scholar
- Markus HS, Clifton A, Brown MM (1994a) Carotid angioplasty: haemodynamic and embolic consequences. Cerebrovasc Dis 4: 259 (abstract)Google Scholar
- Mathias K (1987) Catheter treatment of supra-aortic occlusive vascular disease. Radiologie 27: 547–554Google Scholar
- Mathias KD (1994) Percutaneous transluminal angioplasty in supra-aortic artery disease. In: Roubin GS (ed.) Interventional cardiovascular medicine: principles and practice. 256th ed. Churchill Livingstone, New York, pp 745–775Google Scholar
- Motarjeme A, Keifer JW, Zuska AJ (1982) Percutaneous transluminal angioplasty of the brachiocephalic arteries. AJNR 3: 169–174Google Scholar
- O’Leary DH, Clouse ME (1994) Percutaneous transluminal angioplasty of the cavernous carotid artery for recurrent ischaemia. AJNR 5: 644Google Scholar
- Rothwell P (1995) Morbidity and mortality of carotid endarterectomy in the European Carotid Surgery Trial. Cerebrovasc Dis 4: 226 (abstract)Google Scholar
- Trinca M, Millaire A, Marache P, Jabinet JL, Sergeant O, Ducloux G (1993) Angioplasty of subclavian arteries. Immediate and mid-term results. Ann Cardiol d’Angeiol (Paris) 42:127–132Google Scholar
- Tsai FY, Higashida R, Meoli C (1992) Percutaneous transluminal angioplasty of extracranial and intracranial arterial stenosis in the head and neck. Intervent Neuroradiol 2: 371–384Google Scholar
- Wiggli U, Gratzl O (1983) Transluminal angioplasty of stenotic carotid arteries. Case reports and protocol. Am J Neuroradiol 4: 4793–4795Google Scholar