Australia & New Zealand Society of Vascular Surgeons

Introduction The availability of cerebral protection devices has enabled carotid angioplasty to be performed with a reduced risk from embolization during the procedure. A single operator’s experience using these devices over the last two years is presented. In the latter 18 months all patients requiring a carotid procedure were primarily treated by angioplasty. Method 52 procedures were performed in 44 patients. Mean patient age was 71 ± 8.3 (range 52 – 86). Co-morbidities were cardiac 66%, respiratory 8%, renal 6%, PVD 45%, hypertension 75%, diabetes 22%. Presenting symptoms were transient hemiplegia 17 (33%), amaurosis fugax 14 (27%), minor stroke 6 (11%), re-stenosis 1 (2%), asymptomatic 14 (27%). All procedures were performed percutaneously from the common femoral artery with local anaesthesia. Heparin 5000 to 10,000 U was given intra-arterially. Clopidogrel 150 mg was given 2 hours pre-operatively. The cerebral protection devices employed were the Percusurge in 33, Angioguard 10, Emboshield 2, Filterwire 1, Parodi device 4. The stent used was Carotid Wallstent in 42, Smart stent 6, Balloon expandable coronary stent in 2. Angioseal closure device was used in all cases. Results 50 procedures were completed, 2 were abandoned without morbidity. Carotid ultrasound was performed the day after the procedure. 1 patient had a residual stenosis of 60-80% and had a second procedure where a coronary stent was deployed. The other 49 had no residual stenosis as defined by a > 50% stenosis on ultrasound assessment. Complications were permanent upper half visual loss in 2 (4%), minor stroke 1 (2%), amaurosis fugax 2 (4%). There was 1 false aneurysm sealed by compression and 4 groin haematomas not requiring intervention. At 12 months there was 1 re-stenosis of 50-60% and 2 of 50% on ultrasound assessment in 19 cases. None have required re-intervention. Summary In this operator’s experience, carotid angioplasty is a viable alternative to carotid endarterectomy. The benefits of angioplasty are reduced complications especially of neck haematoma and cranial nerve injury, ease of operation, ability to use large doses of anti-platelet agents and heparin during and after the operation, and patient acceptance. With the development of improved cerebral protection devices and stents, the procedure should be simpler and safer and will be much more widely employed.