Carotid Revascularization Protocol for Symptomatic Stenosis.

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Neurology

Background:

• Carotid endarterectomy (CEA) is the established treatment for symptomatic carotid stenosis (sCS).
• Recent technological advancements necessitate reevaluating carotid artery stenting (CAS) for equivalence to CEA.
• Newer techniques like transcarotid artery revascularization (TCAR) also require assessment.

Purpose of the Study:

• To present an updated algorithm for managing symptomatic carotid stenosis (sCS).
• To compare the safety and effectiveness of CEA, CAS, and TCAR.
• To identify patient-specific factors influencing the risk associated with each procedure.

Main Methods:

• Utilized computed tomography angiography, perfusion imaging, MRI, and carotid duplex ultrasonography for patient selection.
• Implemented dual antiplatelet therapy, statin therapy, and comorbidity optimization preoperatively.
• Employed dual embolic protection (proximal occlusion, distal filters), advanced stents, and aspiration for CAS procedures.

Main Results:

• Demonstrated that CEA, CAS, and TCAR are largely equivalent in safety and effectiveness for managing sCS.
• Highlighted the expanded indications for CAS due to intravascular lithotripsy and integrated embolic protection.
• Identified specific risk factors associated with each revascularization approach.

Conclusions:

• Symptomatic carotid stenosis (sCS) management can be effectively achieved with CEA, CAS, or TCAR.
• Patient selection and procedural technique are crucial for optimizing outcomes.
• The choice of intervention should consider individual patient risk factors and technological advancements.