Toward clinical equipoise: the current case for carotid angioplasty and stent placement.
Recent advances in carotid artery (CA) stent placement procedures have propelled this technology into the forefront of treatment options for both symptomatic and asymptomatic patients with CA stenosis. Until recently, endarterectomy was the only surgical option for patients with CA occlusive disease. For high-risk surgical candidates, periprocedural stroke rates remained unacceptable and were significantly higher than those associated with the natural history of the disease. Advances in stent technology and improvements in antiplatelet and antithrombotic regimens, in conjunction with distal protection devices, have significantly lowered the risk of periprocedural complications for high-risk surgical candidates requiring CA revascularization. In this paper the authors review data gleaned from the important recent CA stent trials and address questions concerning the safety, efficacy, and durability of stent-assisted angioplasty for extracranial CA occlusive disease. Additionally, they review the role of noninvasive imaging modalities for the diagnosis and surveillance of CA disease in these high-risk patients.
Levy
Elad I
EI
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York 14209, USA. elevy@buffns.com
Ecker
Robert D
RD
Thompson
James J
JJ
Rosella
Peter A
PA
Hanel
Ricardo A
RA
Guterman
Lee R
LR
Hopkins
L Nelson
LN
D017130:Angioplasty / Q000009:adverse effects / Q000706:statistics & numerical data; D016893:Carotid Stenosis / Q000473:pathology*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data