Carotid artery stenting
Summary
Stroke prevention is a major public health priority: the surgical option, carotid endarterectomy (CEA), has been available for more than 50 years and has been the standard treatment for critical carotid stenosis in symptomatic and asymptomatic patients. Carotid artery stenting (CAS) is a new and effective endovascular treatment that avoids the pain and morbidity associated with surgery.
Clinical trials have not yet provided clear evidence of superiority of either treatment for “standard operative risk” patients and have been criticized for their design, patient selection, and very variable physician training and credentialing.
Solid evidence is still needed in many aspects of the management of CAS: we are aware that in the field of this specific interventional therapy, rapid changes in available therapeutic techniques create the situation in which clinical practice tends to follow technical developments without evidence from well-designed randomized trials.
In this gap of clear evidence, carotid artery stenting can be an alternative to surgery only if the peri-procedural complications are equal or less than the ones related to carotid endarterectomy. From this perspective, preprocedural evaluation of CAS technical risks, use of cerebral protection devices, stent selection and proper management of CAS complications are all key-points for managing...
Sign up for free!
Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com
- Roffi M, Mukherjee D, Clair DG. Carotid artery stenting vs. endarterectomy. Eur Heart J. 2009;30:2693-704.
- Brott TG, Hobson RW, 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11-23.
- Rosenfield K, Matsumura JS, Chaturvedi S, Riles T, Ansel GM, Metzger DC, Wechsler L, Jaff MR, Gray W; ACT I Investigators. Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis. N Engl J Med. 2016 Mar 17;374(11):1011-20.
- Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W, Hennerici M, Stingele R, Fiehler J, Zeumer H, Jansen O. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008;7:893-902.
- Cremonesi A, Gieowarsingh S, Spagnolo B, Manetti R, Liso A, Furgieri A, Barattoni MC, Ghetti L, Tavazzi L, Castriota F. Safety, efficacy and long-term durability of endovascular therapy for carotid artery disease: the tailored-Carotid Artery Stenting Experience of a single high-volume centre (tailored-CASE Registry). EuroIntervention. 2009;5:589-98.
- Garg N, Karagiorgos N, Pisimisis GT, Sohal DP, Longo GM, Johanning JM, Lynch TG, Pipinos II. Cerebral protection devices reduce periprocedural strokes during carotid angioplasty and stenting: a systematic review of the current literature. J Endovasc Ther. 2009;16:412-27.
- Ansel GM, Hopkins LN, Jaff MR, Rubino P, Bacharach JM, Scheinert D, Myla S, Das T, Cremonesi A; Investigators for the ARMOUR Pivotal Trial. Safety and effectiveness of the INVATEC MO. MA proximal cerebral protection device during carotid artery stenting: results from the ARMOUR pivotal trial. Catheter Cardiovasc Interv. 2010;76:1-8.
- Micari A, Stabile E, Cremonesi A, Vadalà G, Castriota F, Pernice V, Sorropago G, Rubino P, Biamino G. Carotid artery stenting in octogenarians using a proximal endovascular occlusion cerebral protection device: a multicenter registry. Catheter Cardiovasc Interv. 2010;76:9-15.
- Nedeltchev K, Pattynama PM, Biaminoo G, Diehm N, Jaff MR, Hopkins LN, Ramee S, van Sambeek M, Talen A, Vermassen F, Cremonesi A. Standardized definitions and clinical endpoints in carotid artery and supra-aortic trunk revascularization trials. Catheter Cardiovasc Interv. 2010;76:333-44.
- Gray WA, Chaturvedi S, Verta P; Investigators and the Executive Committees. Thirty-day outcomes for carotid artery stenting in 6320 patients from 2 prospective, multicenter, high-surgical-risk registries. Circ Cardiovasc Interv. 2009 Jun;2(3):159-66.