Carotid artery angioplasty is a twenty year old technique. It has been continuously improved upon. Angioplasty now permits treatment of special cases of carotid stenosis even if carotid endarterectomy remains the standard for carotid revascularisation.

A - TECHNIQUE

There are several techniques used for carotid angioplasty. Described below, in simplified fashion, is one of several methods of carotid angioplasty under local anesthetics and sedation with stent and filter. Before the angioplasty, a medication is injected in the patient to alleviate his anxiety and permit him to relax. The patient is then placed as comfortably as possible on the operating table. A local anesthetic is administered in the groin associated with an intravenous sedative. The practitioner punctures the femoral artery and introduces a very fine, flexible catheter of about one meter long. This catheter is pushed upwards endovascularly (through the inside of the arteries) to the carotid stenosis (Figure A). A catheter (a very thin, flexible and resistant tube) with a filter at its extremity is pushed upwards in the same fashion until it reaches the carotid stenosis and the filter is released just above the stenosis (Figure B). Another catheter equipped at its extremity with a stent (a very fine metal mesh tube) is pushed up until it reaches the carotid and is deployed in the carotid stenosis. (Figure C). A catheter equipped with an inflatable cylindrical balloon at its extremity is pushed upwards to the carotid (Figure D) and the balloon is inflated in the carotid stenosis in order to push back the atheroma plaque and widen the arterial passage. (Figure E). The practitioner checks the result of the angioplasty and all the catheters and guides are then removed. (Figure F).

B - COMPLICATIONS

As for surgery, cardio-respiratory complications may arise. The frequency of cerebral vascular accidents is clearly higher than after surgery. (Study EVA-3S). The frequency of damaging nerves passing in proximity of the carotid is much lower than in the case of surgery. Hematomas are rare and center around the point of puncture in the groin.

WARNING

Carotid angioplasty gives less positive results than surgery in the treatment of atheromatous stenosis of the carotid bifurcation (the rate of complications doubles that of surgery in the french study EVA-3S). Carotid angioplasty is nevertheless irreplaceable in certain cases. I recommend asking the advice of a neurologist before being treated by this technique.