title: Endovascular prevention and treatment of stroke related to extracranial carotid artery disease.
abstract: Acute ischemic stroke (AIS) is the leading cause of premature mortality and morbidity worldwide for both men and women. Extracranial carotid artery stenosis/occlusion is responsible for approximately 11.5% of ischemic strokes, whereas extracranial large vessel disease comprises roughly 16.6% of ischemic strokes. Carotid artery disease has been the source of significant debate among neurovascular and cardiovascular specialists, as well as vascular surgeons, as to the best method of revascularization, surgical reconstruction versus endovascular recanalization. There are different treatment modalities and techniques related to AIS and extracranial carotid artery disease based on the different etiologies, and these include acute internal carotid artery occlusion (thrombectomy versus carotid stenting/angioplasty), tandem occlusions (stenting and thrombectomy), and non-emergent carotid stenting/angioplasty for chronic internal carotid artery stenosis. The continuing development of new endovascular technology has led to a major shift in treatment to a minimally invasive endovascular approach. Distal filter devices, proximal protection devices, balloon-guided catheters, open- or closed-cell stents, and flow-reversal stenting are some of the technologies that are now available. The latest treatment techniques, indications, and studies are discussed in this review.
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.|Department of Neurosurgery, Wayne State School of Medicine, Wayne State University, Detroit, MI, USA.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rangel-Castilla
authors.affiliation: Department of Neurosurgery, Wayne State School of Medicine, Wayne State University, Detroit, MI, USA.
authors.forename: Gary B
authors.initials: GB
authors.lastname: Rajah
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.|Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.
authors.forename: Hakeem J
authors.initials: HJ
authors.lastname: Shakir
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.|Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.|Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Davies
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.|Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.|Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.|Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.|Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.|Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.|Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA.|Jacobs Institute, Buffalo, NY, USA.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.|Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.|Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.|Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA - lnhopkins@icloud.com.|Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.|Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.|Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA.|Jacobs Institute, Buffalo, NY, USA.
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002533:Cerebral Angiography; D000072226:Computed Tomography Angiography; D038524:Diffusion Magnetic Resonance Imaging; D057505:Embolic Protection Devices; D006801:Humans; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome