[Indications and limitations of endovascular surgery in carotid revascularization].
Today percutaneous transluminal angioplasty is seldom utilized to treat carotid artery stenosis and the indications and results of this procedure are discordant between the few authors that do it. This leads to caution in selecting PTA as the first choice. Analysing the literature and their own experience, authors describe optimal indications and technique for this procedure. Eight patients with stenosis of the common carotid artery and five patients with stenosis of the internal carotid artery were treated with PTA. In the first group five cases were performed in association with a surgical distal revascularization, to obtain a good run-in. In six cases symptomatic restenosis due to intimal hyperplasia were treated. The two remaining cases were relative to complex clinical situations and high operative risk. In eleven patients out of thirteen a good clinical and hemodynamic result was obtained; in one case the carotid artery occluded and in another case a new restenosis occurred. PTA has some advantages: low operative trauma, cerebral ischemia short time, possibility to treat inaccessible or hardly accessible lesions. The eventuality of complications is high and for this reason the procedure must be utilised only in selected cases, with prudence and with a team well trained in peripheral angioplasty. PTA for carotid artery stenosis today is still an experimental procedure; its value in comparison with carotid endarterectomy has to be proven with well designed clinical randomized trials.