Endovascular treatment of tandem lesions of the carotid arteries.

BACKGROUND: High-grade stenoses of both common (CCA) and the internal (ICA) carotid arteries are rare and represent a therapeutic dilemma for the treating physician. The aim of this article is to present our experience with fully endovascular repair of those lesions.

METHODS: Between January 2011 and December 2012, 5 patients (all male, age 73.6 years) with concomitant CCA and ICA stenoses were treated endovascularly. All patients were asymptomatic. The lesions involved the left carotid in 3 and the right carotid in 2 cases. Common carotid artery stenosis was located at the ostium (1 patient), the middle (3 patients) and the distal segment (1 patient) of the CCA. In 3 cases, CCA stenting was initially performed followed by ICA treatment, whereas in the remaining 2, ICA stenting preceded CCA stenting. A filter embolic protection device was used in 2 cases.

RESULTS: All procedures were successfully completed. Technical success rate was 100%. Mortality rate was 0%. One patient experienced transient neurologic complication. An 82-year-old who underwent left mid-CCA and ICA stenosis without embolic protection device suffered a transient ischemic attack with dysarthria lasting for a few minutes. A 73-year-old patient with left CCA and ICA stenosis and occlusion of the right ICA who underwent stenting under cerebral protection experienced symptoms consistent with cerebral hyperperfusion. Patients were followed up for a mean of 6 months. No neurologic complications or stent restenosis were detected.

CONCLUSIONS: Angioplasty and stenting is a technically feasible method for the treatment of concomitant CCA and ICA stenosis with acceptable short- and mid-term results.