Carotid Artery Stenting in Asymptomatic Carotid Artery Stenosis: JACC Review Topic of the Week
Joshua A Beckman1, Gary M Ansel2, Sean P Lyden3
1Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Endovascular therapies for asymptomatic carotid artery stenosis show promise. Recent trials and advances support their role in stroke prevention for select patients needing revascularization.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Therapeutic advances for asymptomatic carotid artery stenosis (ACAS) have faced challenges over the past decade.
- Disagreements regarding randomized control trials have hindered the adoption of endovascular therapies for ACAS.
- Recent percutaneous therapy advancements offer a robust dataset for endovascular approaches in ACAS.
Purpose of the Study:
- To review recent advancements in endovascular therapies for ACAS over the last five years.
- To re-evaluate the position of endovascular therapy in managing patients with ACAS.
- To clarify the current role of endovascular treatments in ACAS patient care.
Main Methods:
- Systematic review of randomized control trials and recent studies on endovascular therapies for ACAS.
- Analysis of data from the last five years focusing on percutaneous interventions.
- Evaluation of patient selection criteria and revascularization outcomes.
Main Results:
- Significant progress in percutaneous therapies for carotid artery disease has been reported.
- A substantial body of evidence now supports endovascular therapies for select ACAS patients.
- Publication of a second randomized control trial provides further data for re-evaluation.
Conclusions:
- Endovascular therapy is increasingly recognized as a viable component of ACAS management.
- Current evidence supports the incorporation of endovascular procedures for eligible ACAS patients.
- A re-evaluation of endovascular therapy's role in ACAS care is warranted based on recent data.
Abstract:
The advance of therapies to reduce the stroke impact of asymptomatic carotid artery stenosis has proved difficult over the last decade. Disagreement concerning the underlying randomized control trials has limited entry into the care arena of endovascular therapies. Recently, advances in percutaneous therapies for carotid artery disease have been reported and provide a substantial database supporting the further incorporation of endovascular-based therapies in patients who need revascularization and meet selection criteria. With a second randomized control trial now published, it is time for a re-evaluation of endovascular therapy as a component of carotid artery care. This review describes the advances in the field in the last 5 years, clarifying the current position of these therapies in the care of the patient with asymptomatic carotid artery disease.
