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

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.