Angioplasty and stenting for carotid artery stenosis: indications, techniques, results, and complications
G Lanzino1, R D Fessler, R A Mericle
1Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York.
Insights
Angioplasty and stenting offer a safe alternative for high-risk patients with carotid artery stenosis, though careful patient selection is crucial. While major stroke rates are comparable to surgery, minor events may be more frequent in unstable cases.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenosis treatment has expanded to include angioplasty and stenting, inspired by coronary artery disease interventions.
- While not universally indicated, this endovascular approach presents a viable option for select high-risk surgical candidates.
Purpose of the Study:
- To review the current indications and preliminary outcomes of angioplasty and stenting for carotid artery stenosis.
- To describe the procedural techniques involved in endovascular revascularization.
- To explore potential applications for intracranial thromboocclusive carotid artery disease.
Main Methods:
- Review of early and recent clinical series on angioplasty and stenting for carotid artery stenosis.
- Analysis of safety, efficacy, and complication rates compared to surgical intervention.
- Description of procedural techniques for endovascular revascularization.
Main Results:
- Early studies suggest acceptable safety and favorable outcomes for high-risk patients undergoing endovascular treatment.
- Death and major stroke rates appear comparable to surgical options.
- More recent data indicate a potentially higher incidence of perioperative transient neurological events and minor strokes, particularly in patients with recent symptoms or unstable plaques.
Conclusions:
- Angioplasty and stenting represent a potentially safe alternative for carefully selected high-risk patients with carotid artery stenosis.
- Ongoing research and careful patient selection are essential to optimize outcomes and minimize risks, especially concerning minor neurological events.
- The review covers indications, techniques, and future applications, including intracranial disease.
Abstract:
Following the favorable results obtained in the treatment of coronary artery disease, combined angioplasty and stenting has been advocated for the treatment of carotid artery stenosis as well. Although widespread application of angioplasty and stenting for carotid artery disease is neither indicated nor recommended, it may be a viable alternative therapy for select patients who are high-risk patients for surgery. The results of early series have suggested that endoluminal revascularization in these high-risk patients can be performed with an acceptable degree of safety. Although the incidence of death and major stroke rates following angioplasty and stenting procedures compares favorably with surgery, results of more recent clinical series have suggested that the incidence of perioperative transient neurological events and minor strokes may be higher than suggested by earlier reports, especially in patients with recent neurological symptoms and "unstable" plaques. In this article, the authors review the current potential indications for and preliminary results of angioplasty and stenting and describe their procedural technique. In addition, potential applications of stenting to intracranial thromboocclusive carotid artery disease are reviewed.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:26Angina IV: Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Atherosclerosis III: Management
01:26Aneurysm III: Interprofessional Care
01:28Cardiac Catheterization I: Pre-Procedure Overview