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Carotid artery stenting in a vascular surgery practice
Frank J Criado1, Jane M Lingelbach, Dwayne F Ledesma
1Center for Vascular Intervention, Division of Vascular Surgery, Union Memorial Hospital/MedStar Health, Baltimore, MD, USA. frankc@helix.org
Journal of Vascular Surgery
|March 6, 2002
Summary
Carotid angioplasty-stenting (CAS) is safe for high-risk patients undergoing treatment for severe internal carotid artery stenosis. This minimally invasive procedure shows promising results, offering an alternative to traditional surgery.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Severe internal carotid artery (ICA) stenosis poses a significant risk of stroke.
- Carotid endarterectomy (CEA) is the standard treatment, but carries risks for high-risk patients.
- Carotid angioplasty-stenting (CAS) emerged as a less invasive alternative.
Purpose of the Study:
- To evaluate the clinical applicability, technical success, and morbidity of CAS.
- To assess CAS in patients unsuitable for CEA.
- To analyze outcomes in a series of consecutive CAS procedures.
Main Methods:
- A transfemoral access technique and self-expanding stents were used.
- 135 CAS procedures were performed on 132 patients with severe ICA stenosis.
- Standardized technique included balloon pre-dilatation, stenting, and post-dilatation; no brain protection devices were used.
Main Results:
- All procedures were completed successfully, with a low access failure rate (2.2%).
- Neurologic complications included one TIA and two minor strokes; one major stroke occurred due to late stent thrombosis.
- All stented vessels remained patent, with a periprocedural mortality rate of 0%.
Conclusions:
- CAS can be performed safely in carefully selected high-risk patients using standardized techniques.
- CAS may offer a superior alternative to CEA for non-candidates.
- Technological advancements and brain protection devices are expected to further improve CAS outcomes.