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Intermediate outcome after carotid stenting: what should we expect?
M J Silver1, J S Yadav, M Wholey
1Department of Cardiology and Vascular Medicine, Cleveland Clinic Foundation, OH 44195, USA.
Insights
Carotid artery atherosclerosis causes significant disability and death from stroke. Carotid endarterectomy is effective, but new endovascular treatments like angioplasty and stenting are emerging.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Extracranial carotid artery atherosclerosis is a major cause of stroke, a leading cause of death and disability.
- Carotid artery disease accounts for approximately 35% of all ischemic cerebral infarctions, leading to an estimated 150,000 strokes annually in the US.
- Surgical endarterectomy is a proven treatment for severe carotid stenosis in symptomatic and asymptomatic patients.
Purpose of the Study:
- To review the expanding field of carotid artery angioplasty and stenting (CAS).
- To explore newer endovascular revascularization methods for extracranial carotid artery disease.
- To discuss upcoming clinical trials comparing CAS with surgical endarterectomy.
Main Methods:
- Review of current literature on carotid artery angioplasty and stenting.
- Analysis of technological advances in endovascular treatments applied to the extracranial circulation.
- Examination of prospective randomized clinical trials comparing surgical endarterectomy and CAS.
Main Results:
- Carotid endarterectomy has been a heavily scrutinized and effective surgical option for decades.
- Endovascular techniques, including angioplasty and stenting, are increasingly applied to extracranial carotid disease.
- Prospective randomized trials are underway to compare surgical endarterectomy with CAS.
Conclusions:
- Carotid artery angioplasty and stenting represent a rapidly expanding field in treating carotid stenosis.
- The comparison between surgical endarterectomy and CAS will be crucial for future treatment guidelines.
- Further research is needed to establish the optimal revascularization strategy for carotid artery disease.
Abstract:
Atherosclerosis of the extracranial carotid artery is a major public health burden. Stroke is the third leading cause of death in Western countries, after heart disease and cancer, and the leading cause of long-term disability. In the United States, there are more than 500,000 strokes annually, accounting for approximately 3 million stroke survivors with varying degrees of disability. Data from stroke registries suggest that internal carotid artery atheroembolic disease accounts for approximately 35% of all ischemic cerebral infarctions; therefore, approximately 150,000 strokes in the United States per year may be ascribed to carotid disease. Surgical endarterectomy has been shown to be superior to medical management in the management of severe carotid stenosis in both symptomatic and asymptomatic patients. Indeed, carotid endarterectomy has been one of the most heavily scrutinized operations over the past 40 years, and newer methods of revascularization are being actively explored. With the great technological advances in the endovascular treatment of both peripheral and coronary atherosclerotic disease, many of these techniques are now being applied to the extracranial circulation. We explore the rapidly expanding field of carotid artery angioplasty and stenting. The upcoming prospective randomized clinical trials of surgical endarterectomy versus carotid angioplasty and stenting also are reviewed.