Carotid angioplasty and stenting under protection. Techniques, results and limitations.
A carotid stenosis is responsible for about 30% of strokes occurring. Carotid endarterectomy (CEA) is considered to be the gold standard treatment of a carotid stenosis. Carotid angioplasty and stenting (CAS) is emerging as a new alternative treatment for a carotid artery stenosis, but the risk of neurological complications and brain embolism remains the major drawback to this procedure. Therefore, in order to reduce the risks, we need: 1) good indications, good patient and lesion selection; 2) correct techniques; 3) brain protection devices (cerebral protection devices should be routinely used and are mandatory for any procedure); 4) 3 types of protection devices are available, but filters are the most commonly used (all protection devices have limitations and cannot prevent from all embolic events; however, neurological complications can be reduced by 60%); 5) a good choice of the stent and correct implantation (all stents are not equivalent and have different geometrical effects); 6) pharmacological adjuncts; 7) a good team. Recent studies have shown that CAS has superior short-term outcomes than CEA in high surgical risk patients, but there are enough reported data to conclude that CAS is also not inferior to CEA in low-risk patients. CAS under protection is the standard of care and is maybe becoming the gold standard treatment of a carotid stenosis at least in some subgroups of patients.
Henry
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M
Clinic of Cardiology, Nancy, France. m.henryilrmdt@wanadoo.fr
Polydorou
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A
Henry
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I
Anagnostopoulou
I S
IS
Polydorou
I A
IA
Hugel
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M
D000792:Angiography; D017130:Angioplasty / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D017755:Prosthesis Fitting; D015607:Stents; D016896:Treatment Outcome