Carotid Angioplasty and Stenting
Carotid stenosis causes disturbing symptomatology in many patients and is known to increase the risk of stroke. Indeed, the cumulative 5-year risk of stroke in those with severe carotid stenosis and transient ischemic attacks (TIAs) is 30% to 35%.1,2 The gold standard of therapy for carotid artery stenosis is carotid endarterectomy, a surgical technique that has been perfected over more than 40 years.3 The success of percutaneous endovascular intervention in a variety of anatomic regions has led to the introduction of carotid angioplasty and stenting as a means of treating carotid stenosis. Although those of us evaluating the technology would welcome the opportunity to study carotid endovascular interventions in a large clinical trial, sufficient funding has not yet been made available. In the absence of results from a major trial, there is heated debate about the appropriateness of carotid angioplasty and stenting. It has become clear that some carotid lesions are considerably more amenable to endovascular treatment than others. However, we do not yet have a definitive answer about the equivalency of these less invasive procedures with carotid endarterectomy. The current indications for carotid artery angioplasty and stenting are reviewed in this chapter, as are the techniques and clinical results.
KeywordsCarotid Artery Aortic Arch Common Carotid Artery Carotid Endarterectomy Carotid Stenosis
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- 1.Whisnant JP, Wiebers DO: Clinical epidemiology of transient cerebral ischemic attacks on the anterior and posterior circulation. In: Sundt TM Jr, editor: Occlusive cerebrovascular disease: diagnosis and surgical management, Philadelphia, 1987, Saunders, pp 60–65.Google Scholar
- 13.Theron J: Angioplastie carotidienne protegee et stents carotidiens, J Mal Vast 21 (suppl A): 113–122, 1996.Google Scholar
- 14.Gaines P: The European carotid angioplasty trial [abstract], J Endovasc Surg 3: 107, 1996.Google Scholar
- 15.Gaines PA: Carotid angioplasty and CAVATAS update [abstract], J Endovasc Surg 4 (suppl I): 12, 1997.Google Scholar
- 17.Iyer SS, Roubin G, Yadav S et al: Elective carotid stenting [abstract], J Endovasc Surg 3: 105–106, 1996.Google Scholar
- 19.El-Barghouty N, Nicolaides A, Tegos T et al: The relative effect of carotid plaque heterogeneity and echogenicity on ipsilateral cerebral infarction and symptoms of cerebrovascular disease, Int Angiol 15: 300–306, 1996.Google Scholar