Carotid restenosis: Operative and endovascular management

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Presentation transcript:

Carotid restenosis: Operative and endovascular management Robert W. Hobson, MD, Jonathan E. Goldstein, MD, Zafar Jamil, MD, Bing C. Lee, MD, Frank T. Padberg, MD, Abigail K. Hanna, MD, Gary A. Gwertzman, MD, Peter J. Pappas, MD, Michael B. Silva, MD Journal of Vascular Surgery Volume 29, Issue 2, Pages 228-238 (February 1999) DOI: 10.1016/S0741-5214(99)70376-9 Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Preprocedural stenosis in a symptomatic patient (patient 1, Table I) and B, Post-carotid angioplasty-stenting result with an 8 × 20 mm WallStent demonstrated by means of selective arteriograms. Journal of Vascular Surgery 1999 29, 228-238DOI: (10.1016/S0741-5214(99)70376-9) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Preprocedural stenosis in an asymptomatic patient (patient 6, Table I) and B, Post-carotid angioplasty-stenting result with a 10 × 20 mm WallStent shown by means of selective arteriograms. Journal of Vascular Surgery 1999 29, 228-238DOI: (10.1016/S0741-5214(99)70376-9) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Satisfactory apposition of the struts of a WallStent to the arterial wall of the internal carotid artery confirmed by means of intravascular ultrasound. Journal of Vascular Surgery 1999 29, 228-238DOI: (10.1016/S0741-5214(99)70376-9) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 A satisfactory technical result during clinical follow-up (patient 1, Table I) after carotid angioplasty-stenting demonstrated by means of a color Doppler energy scan. Journal of Vascular Surgery 1999 29, 228-238DOI: (10.1016/S0741-5214(99)70376-9) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 A, Stenosis of the left common carotid artery (arrow) at the aortic arch, and B, restenosis of the upper aspect of an autologous vein patch closure (arrow) and a second distal internal carotid stenosis (arrow) shown by means of procedural arteriograms (patient 10, Table I). Journal of Vascular Surgery 1999 29, 228-238DOI: (10.1016/S0741-5214(99)70376-9) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 A, Placement of the WallStent over the shorter Palmaz stent (arrows) with correction of the aortic arch stenosis demonstrated by means of a postprocedural arteriogram (patient 10, Table I). B, A second WallStent that was placed in the internal carotid after dilatation of proximal and distal stenoses. A stenosis, which was not treated, is also seen in the left midsubclavian artery. Journal of Vascular Surgery 1999 29, 228-238DOI: (10.1016/S0741-5214(99)70376-9) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Extension of the WallStent (arrow) into the venous patch-dilated internal carotid artery demonstrated by means of a duplex scan (patient 10, Table I). Apposition of the stent to the arterial wall was not achieved, and serial follow-up scans will be required. Journal of Vascular Surgery 1999 29, 228-238DOI: (10.1016/S0741-5214(99)70376-9) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions