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What are the skills that prepare vascular surgeons for carotid stenting?
Niren Angle1, Peter A Schneider
1Section of Vascular Surgery, University of California San Diego, San Diego, CA 92103-8403, USA. nangle@ucsd.edu
Insights
Carotid stenting is evolving as a stroke prevention therapy, offering an alternative to carotid endarterectomy. Vascular surgeons must acquire new skills to remain experts in treating carotid bifurcation disease.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Endovascular Therapy
Background:
- Carotid endarterectomy is established for stroke prevention in high-grade carotid stenosis.
- The role of carotid stenting compared to endarterectomy is rapidly evolving.
- Prospective randomized trials are ongoing to define definitive evidence.
Purpose of the Study:
- To describe skills for endovascular management of carotid disease.
- To provide strategies for gaining experience in carotid stenting.
- To offer comprehensive treatment options for carotid artery disease.
Main Methods:
- Literature review on carotid stenting techniques and outcomes.
- Analysis of evolving evidence from clinical trials.
- Discussion of skill acquisition pathways for vascular surgeons.
Main Results:
- Carotid stenting is becoming a significant treatment for carotid bifurcation disease.
- Vascular surgeons need to develop endovascular skills to maintain expertise.
- A comprehensive approach to carotid disease management is essential.
Conclusions:
- Carotid stenting will play an increasing role in treating carotid bifurcation disease.
- Vascular surgeons must adapt by acquiring endovascular skills.
- Patient management requires a broad understanding of available treatment options.
Abstract:
Although it has been clearly established that in certain groups of patients, such as in patients with symptomatic high-grade carotid stenosis and in selected asymptomatic patients with high-grade stenosis, carotid endarterectomy offers significant protection from stroke compared with medical therapy, the role of carotid stenting in this patients versus carotid endarterectomy is undergoing a rapid evolution. The definitive evidence awaits the results of ongoing prospective, randomized trials such as CREST and others, but it is clear that carotid stenting will increasingly occupy a significant role in the therapy of carotid bifurcation disease. In that context, vascular surgeons, traditionally the experts on the management of this condition, face the specter of other disciplines intervening in its treatment. In addition, if vascular surgeons do not acquire the skills and the expertise necessary to perform carotid stenting, it is self-evident that they run the risk of being spectators rather retaining the mantle of expert in the management of carotid bifurcation disease. As such, it is the duty of vascular surgeons to acquire the skills with which to retain their rightful place in its management and treatment. The purpose of this article is to describe the skills necessary to become competent in the endovascular management of carotid disease, offer some thoughts and strategy by which one can gain experience and develop an armamentarium of skills necessary to perform carotid stenting, and offer a comprehensive array of options of management and treatment to the patient with carotid disease.
