The role of carotid angioplasty and stenting in carotid revascularization

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.

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Transcarotid artery revascularization (TCAR): a technical video

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-018024 ◽

2021 ◽

pp. neurintsurg-2021-018024

Author(s):

Nanthiya Sujijantarat ◽

Joseph Antonios ◽

Andrew Koo ◽

Daniela Renedo ◽

Branden J Cord ◽

...

Keyword(s):

Routine Clinical Practice ◽

Carotid Angioplasty ◽

Operative Techniques ◽

Content Type ◽

Carotid Revascularization ◽

Endovascular Approach ◽

Angioplasty And Stenting ◽

Video Player ◽

Carotid Angioplasty And Stenting ◽

Stenting Procedure

Carotid revascularization is an important method of stroke prevention and includes carotid endarterectomy and transfemoral carotid angioplasty and stenting. More recently, a hybrid open-endovascular approach, termed transcarotid artery revascularization (TCAR), is garnering increased attention. Although fundamentally a ‘stenting procedure’, unlike transfemoral carotid angioplasty and stenting, TCAR allows for a proximal neuroprotection strategy based on flow reversal. In this technical video, we will review operative techniques and nuances of the TCAR procedure, with a particular focus on the neurovascular proceduralist looking to adopt this technique into routine clinical practice(video 1).Video 1

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The Role of Carotid Angioplasty and Stenting

Seminars in Neurology ◽

10.1055/s-2008-1040903 ◽

1998 ◽

Vol 18 (04) ◽

pp. 501-511 ◽

Cited By ~ 8

Author(s):

Camilo Gomez

Keyword(s):

Carotid Angioplasty ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

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Retinal embolization during carotid angioplasty and stenting: Mechanisms and role of cerebral protection systems

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.10232 ◽

2002 ◽

Vol 56 (3) ◽

pp. 320-327 ◽

Cited By ~ 42

Author(s):

James R. Wilentz ◽

Zukai Chati ◽

Veronique Krafft ◽

Max Amor

Keyword(s):

Cerebral Protection ◽

Carotid Angioplasty ◽

Protection Systems ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

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Safety and Efficacy of Flow Reversal in Acute and Elective Carotid Angioplasty and Stenting Using the Mo.Ma Device with Short-Term Follow-Up

Interventional Neurology ◽

10.1159/000499045 ◽

2019 ◽

Vol 8 (2-6) ◽

pp. 196-205

Author(s):

Ambooj Tiwari ◽

Ryan Bo ◽

Keithan Sivakumar ◽

Karthikeyan M. Arcot ◽

Philip Ye ◽

...

Keyword(s):

Flow Reversal ◽

Carotid Angioplasty ◽

Short Term ◽

Safety And Efficacy ◽

Carotid Revascularization ◽

Subacute Stroke ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting ◽

Radiographic Data

Objective: To determine the safety and efficacy of flow reversal following proximal flow arrest as an embolic protection strategy for carotid angioplasty and stenting (CAS) with short-term follow-up. Method: We performed a retrospective review of our CAS database for patients who underwent stent-supported carotid revascularization in the setting of acute/subacute stroke or TIA. We reviewed clinical and radiographic data during a 36-month period. Primary outcome was clinical evidence of ipsilateral stroke in the first 30 days. Secondary outcomes include clinical outcomes and sonographic and/or angiographic follow-up over 6 months, 6-month functional scale, and all-cause mortality. Results: Fifty-five patients underwent CAS using flow reversal: 26 females and 29 males with a mean age of 69.7 years. Median time to treatment from index event was 3 days. 11% underwent stenting as part of hyperacute stroke therapy. Average luminal stenosis was 86%. The 9-Fr Mo.Ma device was used in combination with Penumbra aspiration in all cases. There were no ipsilateral strokes. Incidence of any ischemic event was 3.64%, but only 1 (1.82%) patient had a postoperative stroke. Clinical follow-up was available for 94.5%, while lesion follow-up was available for 73% of patients. Three patients had evidence of restenosis, but none were symptomatic. Luminal restenosis was ≤30% in all three. Median pre- and post-NIHSS were 1 and 1, respectively. Conclusion: Flow reversal using the Mo.Ma device is a safe and effective strategy in preventing distal embolization during carotid artery revascularization.

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