Article Figures & Data
Figures
- Fig 1.
Suboptimal recanalization results after the placement of a self-expanding Easy Wallstent in the carotid artery. Images demonstrate a lack of apposition between the stent filaments and vessel wall at the bulging of the carotid bulb (arrow).
A, Angiogram shows residual stenosis resulting from stent recoil and gap between stent and arterial wall.
B and C, High-resolution duplex sonogram shows stent recoil after adequate postdilitation of the hyperrchoic plaque and residual flow in the space between stent filaments and vessel wall.
- Fig 2.
Geometric effects of a self-expanding carotid Wallstent in a 78-year-old woman with severe generalized atherosclerotic disease.
A, High-grade stenosis close to the origin of the left ICA with calcified plaque material and an elongated tortuous course distal to the stenosis.
B, The stenosis, including the adjacent curve and carotid bifurcation, was covered with the stent, which was implanted with balloon protection. Note the straightening of the treated segment, with associated kinking and moderate stenosis above the distal end of the stent (arrow); the slight concentric vasospasm at the site of the inflated protective balloon (arrowhead);and stent recoiling and malapposition between the stent filaments and carotid bulb (double arrows).
C, The kinking resolved after rotation of the head to the opposite side.
- Fig 3.
Follow-up angiograms obtained after stent placement.
A, High-grade stenosis at the origin of the ICA is seen.
B, Implantation of a Wallstent completely restored the vascular lumen. Note the slight narrowing at the origin of the ECA and minimal fusiform dilatation above the distal end of the stent at the site of the protective balloon.
C, After 6 mo, the stent is covered by a smooth layer of neointima, which is prominent within the distal CCA. At the flow divider at the bifurcation, a bulblike bulging is seen. The ECA remained patent. Dilatation at the former site of the protective balloon is no longer visible.
Tables
Angiographic Finding Cases (%) All (N = 40) Wallstent and/or Carotid Wallstent (n = 22) Easy Wallstent (n = 18) Optimal widening of lumen and adaptation of stent 11 (28) 6 (27) 5 (28) Residual stenosis 16 (40) 9 (41) 7 (39) Stenosis of ECA origin 9 (23) 5 (23) 4 (22) Residuals of ulcerations 7 (18) 3 (14) 4 (22) Dehiscences of stent and vessel wall 14 (35) 6 (27) 8 (44) Kinking of ICA distal to stent 6 (15) 4 (18) 2 (11) Temporary spasm 10 (25) 5 (23) 4 (22) Dilatation at the site of the protective balloon 3 (8) 3 (14) 0 (0) Note.—Data in parentheses are percentages.
Finding End of Procedure N = 40 1 mo n = 40 3 mo n = 39 6 mo n = 39 Follow-up Angiography n = 7 Follow-up Sonography n = 7 12 mo n = 28 24 mo n = 19 36 mo n = 8 Neurologic event Any stroke 0 (0) 0 (0) 0 (0) 2 (5) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Ipsitateral stroke 0 (0) 0 (0) 0 (0) 1 (3) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Ipsilateral transient ischemic attack 3 (8) 0 (0) 0 (0) 1 (3) 0 (0) 0 (0) 1 (4) 0 (0) 0 (0) Any death 0 (0) 1 (3) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Sonographic finding Residual stenosis (all cases, <30%) 18 (45) 14 (35) 13 (33) 11 (28) 2 (3) 2 (3) 0 (0) 0 (0) 0 (0) Restenosis >50% 0 (0) 0 (0) 0 (0) 1 (3) 1 (1) 1 (1) 0 (0) 0 (0) 0 (0) ECA stenosis 9 (23) 0 (0) 0 (0) 9 (23) 2 (3) 2 (3) 0 (0) 0 (0) 0 (0) Residual ulcerations 5 (13) 0 (0) 0 (0) 2 (5) 1 (1) 1 (1) 0 (0) 0 (0) 0 (0) Lack of apposition stent-vessel wall 11 (28) 0 (0) 0 (0) 6 (15) 1 (1) 1 (1) 0 (0) 0 (0) 0 (0) Incomplete stent coverage of the plaque 6 (15) 0 (0) 0 (0) — 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Incomplete neointimal coverage 0 (0) 0 (0) 0 (0) 11 (28) 2 (3) 2 (3) 0 (0) 0 (0) 0 (0) Stent-induced kinking 4 (10) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Note.—Data in parentheses are percentages.
