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Semin intervent Radiol 2002; 19(4): 321-330
DOI: 10.1055/s-2002-36747
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Carotid Artery Stenting

Nilesh H. Patel1 , Steven J. Willing2
  • 1Section of Vascular and Interventional Radiology, Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
  • 2Interventional Neuroradiology, Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
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Publication History

Publication Date:
21 January 2003 (online)

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ABSTRACT

Carotid artery stenting is a new procedure that is rapidly gaining popularity. There are numerous retrospective studies reported in the literature regarding its feasibility and short- to intermediate-term results. Prospective randomized trials are currently underway to establish the safety and efficacy of the procedure, as well as comparative risk and benefits to carotid endarterectomy (CEA). The technique of carotid artery stenting (CAS), patient management issues, and the role of cerebral protection devices are discussed.

KEYWORD

Atherosclerosis - carotid artery angioplasty - carotid artery stenting

REFERENCES

  • 1 AHA-2001 Heart and Stroke Statistical Update. Dallas, TX: American Heart Association 2001 0: 14-15
    Google Scholar
  • 2 Health Care Financing Review: Medicare and Medicaid Statistical Supplement, 1999, Department of Health and Human Services, Health Care Financing Administration . 
    Google Scholar
  • 3 Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.  N Engl J Med. 1991;  325 445-453
    CrossrefPubMedGoogle Scholar
  • 4 Ferguson G G, Eliasziw M, Barr H W. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients.  Stroke . 1999;  30 1745-1750
    PubMedGoogle Scholar
  • 5 Goldstein L B, Hasselblad V, Matchar D B, McCrory D C. Comparison and meta-analysis of randomized trials of endarterectomy for symptomatic carotid artery stenosis.  Neurology . 1995;  45 1965-1970
    CrossrefPubMedGoogle Scholar
  • 6 Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).  Lancet . 1998;  351 1379-1387
    CrossrefPubMedGoogle Scholar
  • 7 Barnett H J, Taylor D W, Eliasziw M. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.  N Engl J Med . 1998;  339 1415-1425
    CrossrefPubMedGoogle Scholar
  • 8 Sivaguru A, Venables G S, Beard J D, Gaines P A. European carotid angioplasty trial.  J Endovasc Surg . 1996;  3 16-20
    CrossrefPubMedGoogle Scholar
  • 9 Twenty-fourth International Joint Conference on Stroke and Cerebral Circulation, February 1999 (Abst).  Stroke . 2000;  31 2536
    PubMedGoogle Scholar
  • 10 Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial.  Lancet . 2001;  357 1729-1737
    CrossrefPubMedGoogle Scholar
  • 11 New G, Roubin G S, Iyer S S, Vitek J J. Carotid artery stenting: rationale, indications, and results.  Compr Ther . 1999;  25 438-434
    PubMedGoogle Scholar
  • 12 Ohki T, Veith F J. Carotid artery stenting: utility of cerebral protection devices.  J Invasive Cardiol . 2001;  13 47-55
    PubMedGoogle Scholar
  • 13 McCrory D C, Goldstein L B, Samsa G P. Predicting complications of carotid endarterectomy.  Stroke . 1993;  24 1285-1291
    PubMedGoogle Scholar
  • 14 Al-Mubarak N, Roubin G S, Iyer S S. Carotid stenting for severe radiation-induced extracranial carotid artery occlusive disease.  J Endovasc Ther . 2000;  7 36-40
    CrossrefPubMedGoogle Scholar
  • 15 New G, Roubin G S, Iyer S S. Safety, efficacy, and durability of carotid artery stenting for restenosis following carotid endarterectomy: a multicenter study.  J Endovasc Ther . 2000;  7 345-352
    CrossrefPubMedGoogle Scholar
  • 16 Al-Mubarak N, Roubin G S, Iyer S S, Vitek J J, New G. Techniques of carotid artery stenting: the state of the art.  Semin Vasc Surg . 2000;  13 117-129
    PubMedGoogle Scholar
  • 17 Chastain 2nd D H, Gomez C R, Iyer S. Influence of age upon complications of carotid artery stenting. UAB Neurovascular Angioplasty Team.  J Endovasc Surg . 1999;  6 217-222
    CrossrefPubMedGoogle Scholar
  • 18 Mathur A, Roubin G S, Iyer S S. Predictors of stroke complicating carotid artery stenting.  Circulation . 1998;  97 1239-1245
    PubMedGoogle Scholar
  • 19 Vitek J J, Roubin G S, Al-Mubarek N, New G, Iyer S S. Carotid artery stenting: technical considerations.  Am J Neuroradiol . 2000;  21 1736-1743
    PubMedGoogle Scholar
  • 20 Al-Mubarak N, Roubin G S, Gomez C R. Carotid artery stenting in patients with high neurologic risks.  Am J Cardiol . 1999;  83 1411-1413
    CrossrefPubMedGoogle Scholar
  • 21 Mathias K, Jager H, Hennigs S, Gissler H M. Endoluminal treatment of internal carotid artery stenosis.  World J Surg . 2001;  25 328-336
    CrossrefPubMedGoogle Scholar
  • 22 Denninger M H, Necciari J, Serre-Lacroix E, Sissmann J. Clopidogrel antiplatelet activity is independent of age and presence of atherosclerosis.  Semin Thromb Hemost . 1999;  25(Suppl 2) 41-45
    PubMedGoogle Scholar
  • 23 Steinhubl S R, Lauer M S, Mukherjee D P. The duration of pretreatment with ticlopidine prior to stenting is associated with the risk of procedure-related non-Q-wave myocardial infarctions.  J Am Coll Cardiol . 1998;  32 1366-1370
    CrossrefPubMedGoogle Scholar
  • 24 Cadroy Y, Bossavy J P, Thalamas C. Early potent antithrombotic effect with combined aspirin and a loading dose of clopidogrel on experimental arterial thrombogenesis in humans.  Circulation . 2000;  101 2823-2828
    PubMedGoogle Scholar
  • 25 Savcic M, Hauert J, Bachmann F. Clopidogrel loading dose regimens: kinetic profile of pharmacodynamic response in healthy subjects.  Semin Thromb Hemost . 1999;  25(Suppl 2) 15-19
    PubMedGoogle Scholar
  • 26 Mathur A, Dorros G, Iyer S S. Palmaz stent compression in patients following carotid artery stenting.  Cathet Cardiovasc Diagn . 1997;  41 137-140
    CrossrefPubMedGoogle Scholar
  • 27 Hobson R W. Carotid angioplasty-stent: clinical experience and role for clinical trials.  J Vasc Surg . 2001;  33 S117-S123
    PubMedGoogle Scholar
  • 28 Piamsomboon C, Roubin G S, Liu M W. Relationship between oversizing of self-expanding stents and late loss index in carotid stenting.  Cathet Cardiovasc Diagn . 1998;  45 139-143
    CrossrefPubMedGoogle Scholar
  • 29 Crawley F, Stygall J, Lunn S. Comparison of microembolism detected by transcranial Doppler and neuropsychological sequelae of carotid surgery and percutaneous transluminal angioplasty.  Stroke . 2000;  31 1329-1334
    PubMedGoogle Scholar
  • 30 Powers D W. Assessment of the stroke patient using the NIH stroke scale.  Emerg Med Serv . 2001;  30 52-56
    PubMedGoogle Scholar
  • 31 http://www.strokecenter.org/trials/scales/index.htm . 
    Google Scholar
  • 32 Brown M M. Carotid angioplasty and stenting: are they therapeutic alternatives?.  Cerebrovasc Dis . 2001;  11(Suppl 1) 112-118
    PubMedGoogle Scholar
  • 33 Derdeyn C P. Angioplasty and stenting is a reasonable treatment option for many patients with atherosclerotic carotid stenosis.  J Neurosurg Anesthesiol . 2001;  13 274-278
    CrossrefPubMedGoogle Scholar
  • 34 Crawley F, Clifton A, Buckenham T. Comparison of hemodynamic cerebral ischemia and microembolic signals detected during carotid endarterectomy and carotid angioplasty.  Stroke . 1997;  28 2460-2464
    PubMedGoogle Scholar
  • 35 Jaeger H J, Mathias K D, Drescher R. Diffusion-weighted MR imaging after angioplasty or angioplasty plus stenting of arteries supplying the brain.  Am J Neuroradiol . 2001;  22 1251-1259
    PubMedGoogle Scholar
  • 36 Ohki T, Marin M L, Lyon R T. Ex vivo human carotid artery bifurcation stenting: correlation of lesion characteristics with embolic potential.  J Vasc Surg . 1998;  27 463-471
    PubMedGoogle Scholar
  • 37 Theron J, Courtheoux P, Alachkar F, Bouvard G, Maiza D. New triple coaxial catheter system for carotid angioplasty with cerebral protection.  Am J Neuroradiol . 1990;  11 869-874
    PubMedGoogle Scholar
  • 38 Kachel R. Results of balloon angioplasty in the carotid arteries.  J Endovasc Surg . 1996;  3 22-30
    CrossrefPubMedGoogle Scholar
  • 39 Ohki T, Parodi J, Veith F J. Efficacy of a proximal occlusion catheter with reversal of flow in the prevention of embolic events during carotid artery stenting: an experimental analysis.  J Vasc Surg . 2001;  33 504-509
    PubMedGoogle Scholar
  • 40 Ohki T, Roubin G S, Veith F J, Iyer S S, Brady E. Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting: An ex vivo analysis.  J Vasc Surg . 1999;  30 1034-1044
    PubMedGoogle Scholar
  • 41 Reimers B, Corvaja N, Moshiri S. Cerebral protection with filter devices during carotid artery stenting.  Circulation . 2001;  104 12-15
    CrossrefPubMedGoogle Scholar