Carotid artery stenting increased short-term risk for stroke or death more than endarterectomy in symptomatic carotid stenosis

2011 ◽  
Vol 154 (2) ◽  
pp. JC1
Author(s):  
Graeme J. Hankey
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenting ◽  
Short Term ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Early versus late carotid artery stenting for symptomatic carotid stenosis

2015 ◽  
Vol 42 (3) ◽  
pp. 169-175 ◽  
Author(s):  
Luis Henrique de Castro-Afonso ◽  
Guilherme S. Nakiri ◽  
Lucas M. Monsignore ◽  
Antônio C. Dos Santos ◽  
João Pereira Leite ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenting ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

scholarly journals Physician Approaches to Imaging and Revascularization for Acutely Symptomatic Carotid Stenosis: Insights from the Hot Carotid Qualitative Study

2022 ◽  
Vol 2 (1) ◽  
Author(s):  
Aravind Ganesh ◽  
Benjamin Beland ◽  
Gordon A.E. Jewett ◽  
David J.T. Campbell ◽  
Malavika Varma ◽  
...  
Keyword(s):  
Decision Making ◽  
Carotid Artery ◽  
Qualitative Study ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenting ◽  
Practice Patterns ◽  
Imaging Modality ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Background Evidence informing the choice between carotid endarterectomy and carotid artery stenting for acutely symptomatic carotid stenosis (“hot carotid”) is dated and does not factor in contemporary therapies or techniques. The optimal imaging modality is also uncertain. We explored the attitudes of stroke physicians regarding imaging and revascularization of patients with acute symptomatic carotid stenosis. Methods We used a qualitative descriptive methodology to examine decision‐making approaches and opinions of physicians regarding the choice of imaging and revascularization procedures for hot carotids. We conducted semistructured interviews with purposive sampling of 22 stroke physicians from 16 centers in 6 world regions and various specialties: 11 neurologists, 3 geriatricians, 5 interventional neuroradiologists, and 3 neurovascular surgeons. Results Qualitative analysis revealed several themes regarding clinical decision‐making for hot carotids. Whereas CT angiography was favored by most participants, timely imaging availability, breadth of information gained, and surgeon/interventionalist preferences were important themes influencing the choice of imaging modality. Carotid endarterectomy was generally favored over carotid artery stenting, but participants’ choice of intervention was influenced by healthcare system factors such as use of multidisciplinary vascular teams and operating room or angiography suite availability, and patient factors like age and infarct size. Areas of uncertainty included choice of imaging modality for borderline stenosis, utility of carotid plaque imaging, timing of revascularization, and the role of intervention with borderline stenosis or intraluminal thrombus. Conclusions This qualitative study highlights practice patterns common in different centers around the world, such as the general preference for CT angiography imaging and carotid endarterectomy over carotid artery stenting but also identified important differences in availability, selection, and timing of imaging and revascularization options. To gain widespread support, future carotid trials will need to accommodate identified variations in practice patterns and address areas of uncertainty, such as optimal timing of revascularization with modern best medical management and risk‐stratification with imaging features other than just degree of stenosis.

Carotid Artery Stenting May Be Losing the Battle against Carotid Endarterectomy for the Management of Symptomatic Carotid Artery Stenosis, But the Jury Is Still Out

Vascular ◽  
2009 ◽  
Vol 17 (4) ◽  
pp. 183-189 ◽  
Author(s):  
Kosmas I. Paraskevas ◽  
Dimitri P. Mikhailidis ◽  
Frank J. Veith
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Long Term Results ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Carotid artery stenting (CAS) has emerged as a potential alternative to carotid endarterectomy (CEA) for the management of carotid artery stenosis. The purpose of this article is to provide an evaluation and critical overview of the trials comparing the early and later results of CAS with CEA for symptomatic carotid stenosis. The Cochrane Controlled Trials Register, PubMed/Medline, and EMBASE databases were searched up to February 1, 2009, to identify trials comparing the long-term outcomes of CAS with CEA. The MeSH terms used were “carotid artery stenting,” “carotid endarterectomy,” “symptomatic carotid artery stenosis,” “treatment,” “clinical trial,” “randomized,” and “long-term results,” in various combinations. One single-center and three multicenter randomized studies reporting their long-term results from the comparison of CAS with CEA for symptomatic carotid stenosis were identified. All four studies independently reached the conclusion that CAS may not provide results equivalent to those of CEA for the management of symptomatic carotid stenosis. A higher incidence of recurrent stenosis and peri- and postprocedural events accounted for the inferior results reported for CAS compared with CEA. Current data from randomized studies indicate that CAS provides inferior long-term results compared with CEA for the management of symptomatic carotid artery stenosis. However, it can be argued that all of these trials were performed when both CAS equipment and CAS operators had not evolved to their current status. Given that current equipment and mature experience are required for CAS before comparing it with the current “gold standard” procedure (CEA), the results of soon-to-be reported trials (Carotid Revascularization Endarterectomy vs Stenting Trial [CREST], International Carotid Stenting Study [ICSS], or others) may alter the current impression that CAS is inferior to CEA for the treatment of symptomatic carotid stenosis.

Carotid Artery Stenting in Patients With Acute Coronary Syndrome: A Possible Primary Therapy for Symptomatic Carotid Stenosis

2013 ◽  
Vol 20 (4) ◽  
pp. 546-551 ◽  
Author(s):  
Renato Casana ◽  
Alison Halliday ◽  
Paolo Bianchi ◽  
Emanuele Fresa ◽  
Vincenzo Silani ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenting ◽  
Primary Therapy ◽  
Symptomatic Carotid ◽  
Coronary Syndrome ◽  
Symptomatic Carotid Stenosis

scholarly journals Non-protected carotid artery stenting for symptomatic carotid stenosis in low resource settings

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Ayman H. El-Sudany ◽  
Shady S. Georgy ◽  
Amr S. Zaki ◽  
Rady Y. Bedros ◽  
Ahmed El-Bassiouny
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenting ◽  
Cerebral Protection ◽  
Protection Device ◽  
Symptomatic Carotid ◽  
Stent Type ◽  
Symptomatic Carotid Stenosis ◽  
Weighted Magnetic Resonance Imaging ◽  
Stenting Procedure

Abstract Background The use of a distal cerebral protection device during extracranial carotid artery stenting is still a matter of debate. The aim of this work was to evaluate the safety of performing carotid artery stenting procedure without the use of cerebral protection device in patients with symptomatic carotid stenosis. A retrospective study was performed during the period from September 2015 till March 2020 including 91 patients with symptomatic carotid artery stenosis. All patients were treated with a single stent type (Wall stent® - Boston scientific) without the use of cerebral protection device. Pre- and post-procedural clinical assessment with the national institute of health stroke scale (NIHSS). Post procedure brain diffusion-weighted magnetic resonance imaging (DW-MRI) if clinically indicated within 24 h was used to determine periprocedural cerebral embolization. Results A low complication rate was found as only one case (1%) showed mild deterioration in NIHSS and new acute cerebral emboli were detected with brain DW-MRI. Conclusion Carotid artery stenting can be performed safely without the use of cerebral protection device.

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