Endovascular treatment of extra-cranial carotid artery bifurcation disease.
Over the past decade, carotid stenting with embolic protection has emerged as a viable alternative to carotid endarterectomy in patients with severe extra-cranial bifurcation atherosclerotic disease. Several patient subsets -- high surgical risk, symptomatic, asymptomatic, etc.,-- have and are being studied in multi-center trials throughout Europe and the United States. Results of trials to date suggest that, in the high surgical risk cohorts, carotid stenting is statistically on par with endarterectomy with strong trends toward superiority in at least 2 trials SAPPHIRE and ARCHeR. In addition to these important ongoing clinical studies, physician training, reimbursement, and registry development still are in the early stages of evolution in the US.
Gray
W A
WA
Unit of Endovascular Care, Swedish Medical Center, Seattle, WA 98104, USA. william.gray@swedish.org
D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005060:Europe; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D015337:Multicenter Studies as Topic; D015607:Stents; D016896:Treatment Outcome; D014481:United States