State of the art paper Carotid artery stenting – current status of the procedure

Abstract

Surgical carotid endarterectomy (CEA) was long considered the standard approach for the treatment of atherosclerotic carotid artery disease. This was based on results of several randomized trials demonstrating its effectiveness over the best medical therapy. In the past two decades, patients identified high-risk for surgery were offered carotid artery stenting (CAS) as a less invasive option. Despite its initial limitations, CAS has evolved into an elaborate method currently considered to be equivalent and in selected patients even preferable to CEA. However, outcomes of both procedures are highly operator dependent and a simple stratifying method to prioritize CAS, CEA or medical therapy only has not yet been proposed. In addition, recently published randomized trials highlighted the importance of proper patient selection and rigorous training contributing to low absolute rates of (procedural) adverse events. This review discusses the history and evidence for carotid revascularization and briefly presents technical aspects and innovations in CAS.

First-in-man near-infrared spectroscopy proof of lipid-core embolization during carotid artery stenting

“…To our knowledge, this is the first case report of the use of NIRS during CAS. We believe that detection of emboli-prone carotid plaques by NIRS prior to a procedure may improve risk stratification and thereby assist in the selection of CAS versus carotid endarterectomy – a choice that often depends on the relative risks of the two procedures [ 12 , 13 ]. Knowledge of LCP location may assist in placement of stents, and choice of a distal or proximal protection device [ 14 ].…”

Carotid stenting versus endarterectomy for the treatment of carotid artery stenosis: Contemporary results from a large single center study

“…Furthermore, adjusting for symptom status resulted in no significant differences in complication rates between revascularization strategies, suggesting that the higher stroke rate seen in CAS patients may have been driven by a greater proportion of symptomatic patients, which has been associated with worse outcomes, including stroke . Likewise, the degree of stenosis tended to be greater among patients undergoing CAS and this has also been associated with worse periprocedural stroke rates . However, because this was a retrospective study, the degree of stenosis was obtained from operative notes and imaging reports, and thus subject to interpretation bias.…”

Intravascular Near-Infrared Spectroscopy: A Possible Tool for Optimizing the Management of Carotid Artery Disease

“…Currently, either distal protection with a filter or proximal protection devices are routinely used. [36][37][38][39][40] As demonstrated in the coronary arteries, NIRS could be very helpful for predicting the distal embolization of the lipid content. Studies have proved that high LCBI is associated with periprocedural MI.…”