Interventional advances in long-term stroke prevention.
Endovascular angioplasty and stent placement are rapidly emerging therapeutic modalities for selected patients with carotid arterial occlusive disease. Prospective analyses of several large studies have shown that although carotid endarterectomy is the standard of care for most patients, it is associated with significant morbidity and mortality in high-risk patients. When carotid endarterectomy is not feasible in patients with conditions such as contralateral occlusions, recurrent stenosis, and pre-existing cranial palsies, carotid stenting is the treatment of choice. Adjunctive administration of potent antiplatelet agents such as clopidogrel and aspirin appears to reduce the risk of stroke. Currently available embolization-prevention devices and nitinol stents greatly reduce the mortality and morbidity because of embolization during carotid stenting. The spectrum of carotid diseases that can be safely treated with endovascular intervention will increase as new and safer options become available.
Yadav
J S
JS
Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.