Interventional therapy for carotid artery disease using angioplasty and stenting with embolic protection.
Carotid artery angioplasty with stenting (CAS) has emerged as a viable alternative to endarterectomy for the treatment of occlusive vascular disease. Advances in endovascular techniques and the improvement of specialized stents have served to rapidly close the gap with the traditional gold standard surgery. Furthermore, the development of cerebral embolic protection devices has reduced the occurrence of distal embolization of atheromatous material during such interventions and has reduced periprocedural stroke rates considerably. Continued improvements in distal embolic protection have further improved the risk profile of CAS, and increased operator experience with these interventional procedures has also been shown to reduce periprocedural complication rates. Outcomes may continue to improve as more providers gain experience with the evolving endovascular device technology, and several prospective clinical trials are currently investigating the efficacy of CAS with embolization protection versus endarterectomy in different cohorts. This review will survey the background and current literature covering angioplasty and stenting for occlusive disease in the carotid arteries and discuss the current methods employed to prevent distal emboli during intervention.
Loftus
M L
ML
Department of Neurology, Columbia University College of Physicians and Surgeons, Neurological Institute and Columbia Presbyterian Medical Center, 710 West 168th Street, New York, NY 10032, USA.
Schumacher
H C
HC
Meyers
P M
PM
D000800:Angioplasty, Balloon / Q000009:adverse effects; D002340:Carotid Artery Diseases / Q000628:therapy*; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015607:Stents / Q000009:adverse effects