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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Controversies in carotid stenting
Steve Taylor1, Francisco Alcocer, William D Jordan
1Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0016, USA.
Insights
Carotid angioplasty and stenting (CAS) shows improved stroke rates, potentially nearing carotid endarterectomy (CEA) outcomes. However, CAS is recommended only for specific cases, with medical therapy preferred for asymptomatic patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Endovascular therapies are increasingly utilized across various vascular applications.
- The efficacy and safety of carotid angioplasty and stenting (CAS) compared to carotid endarterectomy (CEA) remain under investigation.
- Initial CAS outcomes demonstrated higher stroke morbidity than CEA, failing to meet established guidelines.
Purpose of the Study:
- To evaluate the evolving role and safety of carotid angioplasty and stenting (CAS) in managing carotid artery disease.
- To compare the stroke morbidity and mortality rates of CAS with embolic protection devices against carotid endarterectomy (CEA).
Main Methods:
- Ongoing randomized clinical trials are comparing CAS with embolic protection to CEA.
- Analysis of recent improvements in CAS, including the impact of embolic protection devices.
Main Results:
- Recent advancements have led to improved stroke morbidity rates with CAS, potentially approaching CEA levels.
- Embolic protection devices have reduced embolic complications associated with CAS, though their long-term impact requires further study.
- Initial comparative studies indicated unacceptably high stroke morbidity in the CAS group.
Conclusions:
- CAS is advocated as an adjunct to CEA for select patients unsuitable for surgery.
- Medical therapy remains the primary recommendation for asymptomatic patients with carotid artery disease due to CAS stroke risk exceeding guidelines.
- Further data from ongoing trials are crucial to definitively establish the role of CAS in stroke prevention.
Abstract:
Endovascular therapies are now commonly used in many vascular sites. However, the role for carotid angioplasty and stenting (CAS) remains an unproven therapy with some potential benefits. Initial results of CAS were worse than the surgical standard of carotid endarterectomy (CEA) and did not meet American Heart Association guidelines. However, recent improvements have resulted in improved stroke morbidity rate that may approach that of CEA. Specifically, the embolic problem associated with CAS has been reduced with embolic protection devices, but the ultimate effect of these protection devices remains uncertain. Initial comparison studies of CAS to CEA showed an unacceptably high stroke morbidity rate in the CAS group. As a result, multiple randomized clinical trials have been initiated to compare the results of CAS with embolic protection to that of CEA. While these studies are underway, the authors advocate a careful application of CAS to be used as a complementary tool for the carotid surgeon to use in special circumstances when CEA cannot be undertaken with acceptable morbidity. Furthermore, since the reported stroke morbidity rate of CAS exceeds the AHA recommendation for treatment of asymptomatic patients, most nonsurgical patients with asymptomatic disease should be treated with medical therapy.
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