Technique and clinical evidence of neuroprotection in carotid artery stenting

VASA ◽  
2014 ◽  
Vol 43 (2) ◽  
pp. 100-112 ◽  
Author(s):  
Rainer Knur
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Clinical Evidence ◽  
Carotid Artery Disease ◽  
Balloon Occlusion ◽  
Protection Devices ◽  
Artery Disease ◽  
Distal Filter ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Carotid artery stenting has been advocated as an effective alternative to carotid endarterectomy. Periprocedural embolization of debris during endovascular treatment of carotid artery disease may result in neurological deficit. Different strategies are being developed and evaluated for their ability to minimize the clinical embolic risk. Distal filter devices, proximal and distal balloon occlusion systems are increasingly used in carotid artery stenting, because they seem to be safe and effective in preventing distal embolization, according to several uncontrolled studies. However the use of embolic protection devices is a subject of controversy and no data on their benefit are available from randomized controlled multi-center trials. The technique and clinical evidence of cerebral protection systems during carotid angioplasty and stenting for stroke prevention are reviewed.

Surgical Advances for Extracranial Carotid Stenosis

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S83-S91 ◽  
Author(s):  
Robert E. Harbaugh ◽  
Akshal Patel
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Carotid Angioplasty ◽  
Artery Disease ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Abstract Carotid endarterectomy is a commonly performed operation to prevent stroke in patients who have asymptomatic or symptomatic internal carotid artery atherosclerotic stenosis. Carotid angioplasty and stenting has also been advocated for treatment of these patients. In this article, we address a number of questions for which a review of available data will advance our understanding of the role of carotid endarterectomy in stroke prevention. These include the following: Are carotid endarterectomy and carotid angioplasty and stenting equivalent procedures for the treatment of carotid artery disease? Which patients should be deemed at high risk for carotid endarterectomy? Should carotid endarterectomy be an urgent procedure in symptomatic patients with severe internal carotid artery stenosis? Finally, what is the role of carotid endarterectomy in asymptomatic patients? We also review the senior author's personal experience with >2000 consecutive carotid endarterectomies, with special attention to his present approach to this operation. We believe that carotid endarterectomy, in experienced hands, is a minimally invasive operation that remains the procedure of choice for most patients with carotid artery disease who will benefit from invasive treatment.

Hemodynamic Compromise During Carotid Angioplasty and Stenting

2011 ◽  
Author(s):  
A. G. Lynch ◽  
M. T. Walsh
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Disease ◽  
Arterial Disease ◽  
Neurological Deficits ◽  
Carotid Angioplasty ◽  
Hemodynamic Compromise ◽  
Artery Disease ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Modern surgical treatment of arterial disease is moving towards minimally invasive procedures, as the benefits are numerous. However, one area that is resisting this trend is the treatment of carotid artery disease. For the past number of decades carotid endarterectomy surgery has been referred to as the “gold standard” in the treatment of carotid artery disease. However, in recent year’s carotid angioplasty and stenting (CAS) has emerged to challenge carotid endarterectomy surgery (CES) as a viable alternative for the prevention of strokes. However uptake of this procedure has been hindered due to the peri-operative complications associated with the treatment. During this procedure blood flow in one of the internal carotid arteries supplying blood to the brain is interrupted for a period of time. However, it has been shown that not all patients can accommodate this interruption. Qureshi et al. suggests that ischemic neurological deficits occur in 3 to 13% of patients as a result of hemodynamic compromise.

Transcarotid Artery Revascularization and Advances in Vascular Surgery for Carotid Artery Disease

2021 ◽  
Author(s):  
James Hu ◽  
◽  
Andy Sohn ◽  
Justin George ◽  
Rajesh Malik ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Surgical Management ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Carotid Artery Disease ◽  
Artery Stenosis ◽  
Cerebrovascular Accidents ◽  
Artery Disease

Carotid artery atherosclerotic disease impacts over 2 million Americans annually. Since the advent of the carotid endarterectomy by Debakey in 1953, the surgical management of carotid artery stenosis has prevented cerebrovascular accidents. The technology utilized to manage carotid artery stenosis continued to evolve with the utilization of carotid artery stenting in 1989 and more recently transcarotid artery revascularization (TCAR). This review discusses the modern management of carotid artery stenosis with an emphasis on transcarotid artery revascularization (TCAR) and reversal of flow for reversal of flow for embolic protection.

Angioplasty and stenting for carotid artery stenosis: indications, techniques, results, and complications

1998 ◽  
Vol 5 (6) ◽  
pp. E5 ◽  
Author(s):  
Giuseppe Lanzino ◽  
Richard D. Fessler ◽  
Robert A. Mericle ◽  
Ajay K. Wakhloo ◽  
Lee R. Guterman ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Disease ◽  
Artery Stenosis ◽  
High Risk Patients ◽  
Clinical Series ◽  
Risk Patients ◽  
Artery Disease ◽  
Angioplasty And Stenting

Following the favorable results obtained in the treatment of coronary artery disease, combined angioplasty and stenting has been advocated for the treatment of carotid artery stenosis as well. Although widespread application of angioplasty and stenting for carotid artery disease is neither indicated nor recommended, it may be a viable alternative therapy for select patients who are high-risk patients for surgery. The results of early series have suggested that endoluminal revascularization in these high-risk patients can be performed with an acceptable degree of safety. Although the incidence of death and major stroke rates following angioplasty and stenting procedures compares favorably with surgery, results of more recent clinical series have suggested that the incidence of perioperative transient neurological events and minor strokes may be higher than suggested by earlier reports, especially in patients with recent neurological symptoms and “unstable” plaques. In this article, the authors review the current potential indications for and preliminary results of angioplasty and stenting and describe their procedural technique. In addition, potential applications of stenting to intracranial thromboocclusive carotid artery disease are reviewed.

Carotid artery stenting in occlusive carotid artery disease: An appraisal

2019 ◽  
Vol 67 (6) ◽  
pp. 1429
Author(s):  
KamleshSingh Bhaisora ◽  
Suyash Singh ◽  
KuntalKanti Das
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Carotid Artery Disease ◽  
Artery Disease
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