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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Carotid artery disease and stenting: insights from recent clinical trials
Ronan Margey1, Douglas E Drachman
1Cardiology Division, Section of Vascular Medicine, Massachusetts General Hospital and Harvard Medical School, Gray-Bigelow 800, 55 Fruit Street, Boston, MA, 02114, USA.
Insights
Cerebrovascular disease, particularly ischemic stroke from carotid artery stenosis, poses significant health risks. This review examines optimal medical therapy, carotid endarterectomy, and stenting to reduce stroke risk.
Area of Science:
- Neurology
- Vascular Surgery
- Cardiology
Background:
- Cerebrovascular disease is a major cause of death and disability in the US.
- Ischemic strokes account for 80% of all strokes, with carotid artery atherosclerosis being a significant contributor.
- Both symptomatic and asymptomatic carotid stenosis carry substantial stroke risks.
Purpose of the Study:
- To review current evidence on managing carotid stenosis.
- To compare the efficacy of medical therapy, carotid endarterectomy, and angioplasty with stenting.
- To guide patient- and lesion-specific treatment decisions.
Main Methods:
- Review of existing literature on carotid stenosis management.
- Analysis of data regarding medical therapy, carotid endarterectomy, and carotid angioplasty with stenting.
- Evaluation of stroke risk reduction strategies.
Main Results:
- Carotid endarterectomy has a proven track record in reducing stroke risk for severe stenosis.
- Medical therapy has advanced significantly.
- Carotid angioplasty and stenting offer an alternative endovascular approach.
Conclusions:
- Optimal management of carotid stenosis requires consideration of patient and lesion characteristics.
- A combination of medical therapy, endarterectomy, and stenting provides options for stroke risk reduction.
- Tailoring treatment strategies is key to improving patient outcomes.
Opinion Statement:
Cerebrovascular disease remains a leading cause of morbidity, mortality, and health care expenditure in the United States. Approximately 80% of strokes are ischemic in origin, with 20% to 25% due to atherosclerotic disease of the carotid artery. It is well established that untreated, symptomatic carotid stenosis confers a 25% risk of stroke within 2 years, and that asymptomatic carotid stenosis > 60% is associated with an 11% stroke risk at 5 years. Over the past six decades, surgical revascularization with carotid endarterectomy, when performed by experienced surgeons, has been demonstrated to be effective in reducing stroke risk in patients with severe stenosis. During the same time, medical therapy has improved considerably, and endovascular therapy with carotid angioplasty and stenting has emerged as an important alternative strategy that may play a significant role in reducing the risk of stroke in patients with carotid disease. In this review, we examine the current evidence regarding optimal medical therapy, endarterectomy, and stenting for the management of patients with carotid stenosis. Armed with these data, we may tailor our approach to optimize care based on patient- and lesion-specific considerations.
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