Current status in cervical carotid artery stent placement

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Neurology

Background:

• Extracranial carotid arterial disease management is debated, with options including surgery, stenting, or medical therapy.
• Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are key interventions for preventing stroke.

Purpose of the Study:

• To review global registries and trials on CAS versus CEA for extracranial carotid arterial disease.
• To evaluate the efficacy and safety of CAS in symptomatic and asymptomatic patients.

Main Methods:

• Systematic review of carotid artery stent and endarterectomy registries and trials.
• Analysis of over 14,000 patients undergoing carotid stenting.
• Evaluation of complication rates, stroke, death, and restenosis rates.

Main Results:

• CAS demonstrates substantial benefit for high anatomic risk symptomatic patients.
• Complication rates for CAS in symptomatic patients, including octogenarians, are improving.
• Neurological outcomes, stroke, and death rates for CAS are comparable or better than CEA.
• CAS meets CMS targets for Major Adverse Events (MAE): 3% for asymptomatic and 6% for symptomatic patients.

Conclusions:

• CAS is a viable option for high-risk symptomatic patients unsuitable for medical therapy or CEA.
• The role of CAS in asymptomatic patients and octogenarians requires further investigation.
• Carotid stenting, with appropriate patient selection and experienced operators, is an effective procedure with ongoing development.