Endoluminal stent reconstruction of low-grade, symptomatic carotid plaques: a treatment alternative—report of two cases

Abstract

Introduction—Medical treatment of low-grade (<50% luminal narrowing) symptomatic carotid stenosis
has been the treatment of choice because trial data showed no evident benefit to carotid endarterectomy for
these patients. Such patients may have recurrent neurological symptoms despite adequate medical therapy
owing to recurrent plaque rupture. In such cases, carotid stenting may represent an option for treatment but
has not been tested in trials because of previous failure of carotid endarterectomy to demonstrate any benefit for patients with low-grade carotid stenosis. The cases presented here illustrate the perioperative safety
and potential benefit of carotid stenting for such patients with persistent neurological symptoms despite
adequate medical therapy.
Case material—Two patients with low-grade stenosis and recurrent transient ischemic attack or stroke
despite antiplatelet therapy were treated with carotid stenting. Both patients were treated after recent ipsilateral neurological events in the absence of an evident cardioembolic source. Carotid plaque ulceration
thought to be related to the ischemic events was present in both cases. No perioperative complications were
noted. On followup, the patients showed resolution of symptoms and had no new neurological events.
Conclusion—Carotid stenting of low-grade but symptomatic carotid plaque refractory to medical management represents a surgical option for treatment. Further studies may be warranted to evaluate stenting as
a suitable treatment option.