Imaging for carotid stenting

Area of Science:

• Vascular Surgery
• Interventional Neurology
• Medical Imaging

Background:

• Carotid artery stenting (CAS) with embolic protection devices (EPD) is a viable alternative to carotid endarterectomy (CEA) for select patients.
• Accurate patient selection is crucial for CAS success and minimizing complications.
• Neurologic adverse events are more common during CAS than CEA.

Purpose of the Study:

• To review imaging techniques for optimizing patient selection in carotid artery stenting.
• To identify methods for minimizing neurologic adverse events during CAS.

Main Methods:

• Review of current literature on imaging modalities for carotid artery assessment.
• Evaluation of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) advancements.
• Comparison of imaging utility versus duplex ultrasonography for CAS suitability.

Main Results:

• Duplex ultrasonography alone is insufficient for assessing CAS suitability.
• CTA and MRA advancements aid in identifying vulnerable lesions prone to embolization.
• Advanced imaging improves the identification of patients who would benefit from CAS.

Conclusions:

• Advanced imaging techniques, including CTA and MRA, are essential for appropriate patient selection in CAS.
• Improved patient selection through imaging can significantly reduce neurologic adverse events associated with CAS.