The Endovascular Treatment of Carotid and Vertebral Artery Atherosclerotic Disease

  • Andrew Clifton
  • Martin M. Brown


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.


Vertebral Artery Carotid Endarterectomy Carotid Stenosis Asymptomatic Carotid Internal Carotid Artery Stenosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Bogey WM, Demasi RJ, Tripp MD, Vithalani R, Johnsrude IS, Powell SC (1994) Percutaneous transluminal angioplasty for subclavian artery stenosis. Am Surg 60: 103–106PubMedGoogle Scholar
  2. Bockenheimer S, Mathias K (1983) Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis. AJNR 4: 791–792PubMedGoogle Scholar
  3. Brown MM (1992) Balloon angioplasty for cerebrovascular disease. Neurol Res 14 (supplement): 159–173PubMedGoogle Scholar
  4. Buchan A, Gates P, Pelz D, Barnett HM (1988) Intraluminal thrombus in the cerebral circulation: implications for surgical management. Stroke 19: 681–687PubMedCrossRefGoogle Scholar
  5. Burke DR, Gordon RL, Mishkin JD, McLean GK, Meranze SG (1987) Percutaneous transluminal angioplasty of subclavian arteries. Radiology 164: 699–704PubMedGoogle Scholar
  6. Castaneda-Zuniga WR, Formanek A, Tadavarthy M et al. (1980) The mechanisms of balloon angioplasty. Radiology 135: 565–571PubMedGoogle Scholar
  7. Crawley F, Clifton A, Markus H, Brown MM (1997) Delayed improvement in carotid artery diameter after carotid angioplasty. Stroke 28(3): 574–579PubMedCrossRefGoogle Scholar
  8. Crawley F, Brown MM, Clifton AG (1998) Angioplasty and stenting in the carotid and vertebral arteries. Postgrad Med J 74: 7–10PubMedCrossRefGoogle Scholar
  9. Dorros G, Lewin RF, Jamnadas P, Mathiak LM (1990) Peripheral transluminal angioplasty of the subclavian and innominate arteries utilizing the brachial approach: acute outcome and follow-up. Cathet Cardiovasc Diagn 19: 71–76PubMedCrossRefGoogle Scholar
  10. Eckert B, Zanella FE, Thie A, Steinmetz J, Zeumer H (1996) Angioplasty of the internal carotid artery: results, complications and follow-up in 61 cases. Cerebrovasc Dis 6: 97–105CrossRefGoogle Scholar
  11. European Carotid Surgery Trialists Collaboration Group (1991) MRC European carotid surgery trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 337: 1235–1243CrossRefGoogle Scholar
  12. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995) Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273: 1421–1428CrossRefGoogle Scholar
  13. 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
  14. Freitag G, Freitag J, Koch RD (1987) Transluminal angioplasty for the treatment of carotid artery stenosis. Vasa 16: 67–71PubMedGoogle Scholar
  15. Gaines PA (1993) Carotid angioplasty and sinus arrhythmias. Clini Radiol 48: 431–433CrossRefGoogle Scholar
  16. Gil-Peralta A, Mayol A, Gonzalez A, et al. (1996) Percutaneous transluminal angioplasty of symptomatic atherosclerotic carotid arteries: results, complications and follow-up. Stroke 27: 2271–2273PubMedCrossRefGoogle Scholar
  17. Health and Public Policy Committee American College of Physicians (1983) Percutaneous transluminal angioplasty. Ann Int Medi 99: 864–869Google Scholar
  18. 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
  19. Higashida RT, Tsai FY, Halbach V et al. (1993) Transluminal angioplasty for atherosclerotic disease for the vertebral and basilar arteries. J Neurosurg 78: 192–198PubMedCrossRefGoogle Scholar
  20. Insall RL, Lambert D, Chamberlain J, Proud G, Murthy LN, Loose HW (1990) Percutaneous transluminal angioplasty of the innominate, subclavian and axillary arteries. Eur J Vase Surg 46: 591–595CrossRefGoogle Scholar
  21. Kachel R, Basche ST, Heerklotz I, Grossman K, Endler S (1991) Percutaneous transluminal angioplasty (PTA) of supra-aortic arteries, especially internal carotid artery. Neuroradiology 33: 191–194PubMedCrossRefGoogle Scholar
  22. Lambert M (1995) Should carotid endarterectomy be purchased? Purchasers need a broader perspective. BMJ 310: 317–318PubMedCrossRefGoogle Scholar
  23. Marks MP, Dake MD, Steinberg GK, Norbash AM, Lane B (1994) Stent placement for arterial and venous cerebrovascular disease: preliminary experience. Radiology 191: 441–446PubMedGoogle Scholar
  24. Markus HS, Clifton A, Brown MM (1994a) Carotid angioplasty: haemodynamic and embolic consequences. Cerebrovasc Dis 4: 259 (abstract)Google Scholar
  25. Markus HS, Clifton A, Buckenham T, Brown MM (1994b) Carotid angioplasty: detection of embolic signals during and after the procedure. Stroke 25: 2403–2406PubMedCrossRefGoogle Scholar
  26. Mathias K (1987) Catheter treatment of supra-aortic occlusive vascular disease. Radiologie 27: 547–554Google Scholar
  27. 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
  28. McCormick PM, Spetzler RF, Baues JE, Zambramski JM, Frey JL (1992) Thrombo-endarterectomy of the symptomatic occluded internal carotid artery. J Neurosurg 76: 752–758PubMedCrossRefGoogle Scholar
  29. Millaire A, Trinca M, Marache P, de Groote P, Jabinet JL, Ducloux G (1993) Subclavian angioplasty: immediate and late results in 50 patients. Cathet Cardiovasc Diagn 29: 8–17PubMedCrossRefGoogle Scholar
  30. Motarjeme A, Keifer JW, Zuska AJ (1982) Percutaneous transluminal angioplasty of the brachiocephalic arteries. AJNR 3: 169–174Google Scholar
  31. Munari LM, Belloni G, Perretti A, Gatti A, Moschini L, Porta M (1992) Carotid percutaneous angioplasty. Neurol Res 14 (supplement): 156–158PubMedGoogle Scholar
  32. North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. New Engl J Medi 325:445–453CrossRefGoogle Scholar
  33. O’Leary DH, Clouse ME (1994) Percutaneous transluminal angioplasty of the cavernous carotid artery for recurrent ischaemia. AJNR 5: 644Google Scholar
  34. Rostmily RC, Mayberg MR, Eskridge JM, Goodkin R, Winn HR (1992) Resolution of petrous internal carotid artery stenosis after transluminal angioplasty: case report. J Neurosurg 76: 520–523CrossRefGoogle Scholar
  35. Rothwell P (1995) Morbidity and mortality of carotid endarterectomy in the European Carotid Surgery Trial. Cerebrovasc Dis 4: 226 (abstract)Google Scholar
  36. Sundt TM, Sandock BA, Whisnant JP (1975) Carotid endarterectomy: complications and preoperative assessment of risk. Mayo Clin Proc 50: 301–306PubMedGoogle Scholar
  37. Theron J, Courtheouz P, Alachkar F, Bouvard G, Maiza D (1990) New triple coaxial catheter system for carotid angioplasty with cerebral protection. AJNR 11: 869–874PubMedGoogle Scholar
  38. 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
  39. Tsai FY, Matovich V, Hieshima GB et al. (1986) Percutaneous transluminal angioplasty of the carotid artery. AJNR 7: 349–358PubMedGoogle Scholar
  40. 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
  41. Vitek JJ, Keller FS, Duvall ER, Gupta KL, Chandra-Sekar B (1986) Brachiocephalic artery dilation by percutaneous transluminal angioplasty. Radiology 158: 779–785PubMedGoogle Scholar
  42. Warlow CP (1995) Endarterectomy for asymptomatic carotid stenosis? Lancet 345: 1254–1255PubMedCrossRefGoogle Scholar
  43. Wiggli U, Gratzl O (1983) Transluminal angioplasty of stenotic carotid arteries. Case reports and protocol. Am J Neuroradiol 4: 4793–4795Google Scholar

Copyright information

© Springer-Verlag London 2000

Authors and Affiliations

  • Andrew Clifton
  • Martin M. Brown

There are no affiliations available

Personalised recommendations