• Tomoaki Terada, Mitsuharu Tsuura, Hiroyuki Matsumoto, Osamu Masuo, Tomoyuki Tsumoto, Hiroo Yamaga, and Toru Itakura.
• Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan. teradato@wakayama-med.ac.jp
• Neurosurgery. 2006 Aug 1; 59 (2): 301-9; discussion 301-9.

ObjectiveThe surgical benefit to pseudo-occlusion of the internal carotid artery (ICA) is controversial. Because the benefit of carotid endarterectomy for pseudo-occlusion of the ICA remains uncertain, we examined the use of carotid stenting as a possible alternative treatment for this condition.MethodsTwenty cases of carotid pseudo-occlusion (17 symptomatic, three asymptomatic) were treated with carotid artery stenting. Nineteen patients were treated with various embolic protection techniques. Our clinical results, including angiographic follow-up data, perioperative complications, and data on the effectiveness of the embolic protection methods were studied for ICA pseudo-occlusion.ResultsAll pseudo-occlusions were successfully dilated, and the stenotic ratio was reduced from 95 to 6.7% on average. No neurological deterioration was encountered in any of the cases, although one patient died of cardiac event 1 day after treatment. None of the patients experienced stroke during the mean 24.8 month follow-up period, although one patient died from myocardial infarction. Among the 17 cases in which follow-up angiography was performed at 6 months after stenting, only one patient demonstrated restenosis. This patient was successfully treated with repeated percutaneous transluminal angioplasty. The rate of restenosis in our series was 5.9%, and the morbidity/mortality rate within 30 days was 5%.ConclusionThe clinical results of carotid stenting for ICA pseudo-occlusion under embolic protection were fairly good from the viewpoints of periprocedural neurological morbidity, angiographic follow-up results, and stroke prevention. Carotid stenting can be considered an alternative to carotid endarterectomy in patients with ICA pseudo-occlusion.

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