Cases of carotid, subclavian and vertebral angioplasty with stenting for stroke prevention at the St. Lukes Medical Center.

BACKGROUND AND OBJECTIVE: The great majority of strokes are a consequence of atherosclerosis. Its major complication is thrombosis clinically manifesting as coronary heart disease, peripheral arterial disease and cerebral ischemia. The criterion for diagnosing atherothrombosis as the underlying mechanism of stroke is the presence of 50 percent stenosis of a cervical artery after exclusion of other potential causes. Optimal management includes modification of these risk factors, antiplatelet therapy and carotid revascularization in patients with high-grade carotid stenosis
Our objective is to present serial cases of angioplasty and stenting performed on major arterial supplies to the brain to facilitate collaborative endeavors
SUMMARY OF CASES: We report 10 angioplasty with stenting procedures done at St. Lukes Medical Center for high-grade carotid stenosis (n=7), vertebral artery disease (n=1), brachiocephalic artery disease (n=1), and subclavian steal syndrome (n=1). Mean age of the patients was 65.9 years (range 48 to 76 years old) of which majority were males (70 percent). The most common risk factors were hypertension (50 percent), heart disease (50 percent), and smoking (30 percent). Eight procedures were done on symptomatic vessels. All had 65 percent stenosis. All patients tolerated the procedure well with good postdilatation flow
CONCLUSION: For surgically high-risk patients and those with surgically inaccessible vascular disease, stenting currently may represent a suitable alternative for endarterectomy. Among our ten cases, it appears to be a safe and effective procedure. However, further research has to be done on its durability in reducing long-term recurrent neurological events. This is being investigated with acceptable outcome in many centers worldwide. (Author)