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Skin to Skin: Transfemoral Carotid Angiography and Stenting
1Wellmont CVA Heart Institute, PV Dept, 2050 Meadowview Parkway, Kingsport, TN, 37660, USA.
Insights
Carotid artery stenting (CAS) offers comparable results to carotid endarterectomy (CEA) for treating carotid artery disease. Optimal outcomes with CAS depend on experienced operators and centers, emphasizing careful patient selection.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenting (CAS) is an emerging alternative to carotid endarterectomy (CEA).
- Recent trials show promising results for CAS, including in high-risk patients.
- North American trials indicate CAS is equivalent to CEA in both high-risk and standard-risk populations.
Purpose of the Study:
- To evaluate the effectiveness and safety of CAS compared to CEA.
- To analyze the impact of operator and center experience on CAS outcomes.
- To understand the role of case selection in achieving successful CAS procedures.
Main Methods:
- Review of randomized North American trials comparing CAS and CEA.
- Analysis of procedural outcomes based on patient risk stratification (high-risk vs. standard-risk).
- Assessment of factors influencing CAS success, including operator and center experience.
Main Results:
- CAS demonstrates equivalent outcomes to CEA in various patient risk groups.
- Significant improvements in CAS results are observed.
- These advancements are linked to operator experience and refined case selection strategies.
Conclusions:
- CAS is a viable alternative to CEA for carotid artery disease treatment.
- Achieving optimal CAS results requires specialized expertise and experienced centers.
- Appropriate patient selection is crucial for maximizing the benefits of CAS.
Abstract:
Carotid artery stenting (CAS) has emerged as an attractive alternative to carotid endarterectomy (CEA) for the treatment of carotid artery disease. Several recent trials demonstrate excellent and improving results, even at high risk in CEA patients. Randomized North American trials suggest equivalence of CAS to CEA in high-risk and standard-risk patients. However, these improved CAS results apply only to CAS procedures performed by experienced operators at experienced centers. Furthermore, these improved results are due largely to operators' lessons learned, helping with appropriate case selection.