Carotid Artery Stenting in Asymptomatic Carotid Artery Stenosis: JACC Review Topic of the Week.
Creator
Beckman JA; Ansel GM; Lyden SP; Das TS
Publisher
Journal of the American College of Cardiology
Date
2020
2020-02-18
Description
The advance of therapies to reduce the stroke impact of asymptomatic carotid artery stenosis has proved difficult over the last decade. Disagreement concerning the underlying randomized control trials has limited entry into the care arena of endovascular therapies. Recently, advances in percutaneous therapies for carotid artery disease have been reported and provide a substantial database supporting the further incorporation of endovascular-based therapies in patients who need revascularization and meet selection criteria. With a second randomized control trial now published, it is time for a re-evaluation of endovascular therapy as a component of carotid artery care. This review describes the advances in the field in the last 5 years, clarifying the current position of these therapies in the care of the patient with asymptomatic carotid artery disease.
Carotid Endarterectomy and Carotid Artery Stenting in a Predominantly Symptomatic Real-World Patient Population.
Creator
Howie Benjamin A; Witek Alex M; Hussain M Shazam; Bain Mark D; Toth Gabor
Publisher
World neurosurgery
Date
2019
2019-04
Description
OBJECTIVE: Carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) are well established treatments that have been shown to decrease stroke recurrence in patients with underlying carotid artery disease. We assessed clinical outcome, safety and restenosis rates for patients who underwent standardized CEA or CAS at our tertiary care center using patient selection criteria based on available scientific evidence. METHODS: Retrospective chart review of patients who underwent CEA or CAS between 2009 and 2016. RESULTS: In total, 314 cases (204 CEA and 110 CAS) were analyzed. Patients were predominantly non-Hispanic Caucasian (84.4%), males (61.1%) with hypertension (86.9%) and hyperlipidemia (81.8%). Most patients (84.5%) had symptomatic carotid disease. No significant differences were observed in median post-operative NIHSS and mRS scores based on pre-treatment symptomatic status, or treatment modality (CEA vs CAS). Most patients (85.9%) had favorable outcomes (mRS 0-2) at a median follow-up of 11.7 months (IQR 1.8- 28.8). The perioperative complication rate was low (3.2%), and permanent neurologic deficit was seen in only 3 patients (1%). Restenosis was found in 7.3% without significant difference between CEA and CAS at last follow-up. Restenosis was asymptomatic in the majority of patients. CONCLUSIONS: Our findings in a real-world predominantly symptomatic cohort demonstrate that favorable patient outcomes, and low restenosis and complication rates can be achieved with both CEA and CAS by the utilization of a consistent institutional patient selection and treatment process.