carotid artery stenting (CAS)

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[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]

Introduction

Carotid artery angioplasty with stenting is a less invasive alternative to carotid endarterectomy[2]

Indications

* indications for carotid stenting vs CEA in high-risk patients in need of reconsideration[12]

Contraindications

  • avoid in patients age 70 years & older[8][14] (contrast with indications ref[6])
  • medical therapy under-utilized[9]

Complications

* A filter basket may be placed distal to the stenosis via a guidewire. After the procedure, the filter & its captured embolic material is removed[2]

Notes

Comparison with carotid endarterectomy (CEA):

More general terms

Additional terms

References

  1. ↑ Ovbiagele B, In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
  2. ↑ 2.0 2.1 2.2 Journal Watch 24(22):165, 2004 Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K; Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004 Oct 7;351(15):1493-501. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15470212
  3. ↑ 3.0 3.1 The SPACE Collaborative Group, 30 day results from the SPACE trial of stent-protected angioplasty vs carotid endarterectomy in symptomatic patients. A randomized non-inferiority trial. Lancet 2006, 368:1239 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17027729
    Naylor AR SPACE: Not the final frontier Lancet 2006, 368:1215 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17027708
  4. ↑ 4.0 4.1 4.2 Mas J-L et al. for the EVA-3S Investigators. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 2006 Oct 19; 355:1660-71 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17050890
    Furlan AJ. Carotid-artery stenting - Case open or closed? N Engl J Med 2006 Oct 19; 355:1726-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17050898
  5. ↑ 5.0 5.1 5.2 Fairman R, Gray WA, Scicli AP, Wilburn O, Verta P, Atkinson R, Yadav JS, Wholey M, Hopkins LN, Raabe R, Barnwell S, Green R; for the CAPTURE Trial Collaborators. The CAPTURE registry: analysis of strokes resulting from carotid artery stenting in the post approval setting: timing, location, severity, and type. Ann Surg. 2007 Oct;246(4):551-6; discussion 556-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/1789349
  6. ↑ 6.0 6.1 6.2 Chiam PT et al One-year clinical outcomes, midterm survival, and predictors of mortality after carotid stenting in elderly patients. Circulation 2009 May 5; 119:2343. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19380623
    Belkin M and Bhatt DL Carotid stenting in the elderly: Is 80 the new 60? Circulation 2009 May 5; 119:2302. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19414655
  7. ↑ Roubin GS et al for the CREST investigators Surgery, stenting to open blocked neck arteries similar in safety, efficacy, but show differences in stroke, heart attack and death rates at certain ages: Abstract 197 American Heart Association/American Stroke Association American Stroke Association late-breaking science report: SAN ANTONIO, Feb. 26, 2010 http://americanheart.mediaroom.com/index.php?s=43&item=971
    International Carotid Stenting Study investigators Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial Lancet 2010 Mar 20; 375:985. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20189239 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960239-5/abstract
    Bonati LH et al New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy the International Carotid Stenting Study (ICSS). Lancet Neurol. 2010 Apr;9(4):353-62 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20189458
    Rothwell PM. Carotid stenting: More risky than endarterectomy and often no better than medical treatment alone. Lancet 2010 Mar 20; 375:957. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20304225
  8. ↑ 8.0 8.1 8.2 Carotid Stenting Trialists Collaboration Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data Lancet 2010 Sep 25; 376:1062. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20832852 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61009-4/abstract
  9. ↑ 9.0 9.1 9.2 Journal Watch Neurology, October 18, 2011 Massachusetts Medical Society Carotid Artery Stenting in the Real World http://neurology.jwatch.org/cgi/content/full/2011/1018/2?q=etoc_jwgenmed
    Nallamothu BK et al. Operator experience and carotid stenting outcomes in Medicare beneficiaries. JAMA 2011 Sep 28; 306:1338. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21954477
    Halm EA. Carotid stenting at the crossroads: Practice makes perfect, but some may be practicing too much (and not enough). JAMA 2011 Sep 28; 306:1378. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21954482
  10. ↑ 10.0 10.1 Tulip HH et al. Cerebral embolization in asymptomatic versus symptomatic patients after carotid stenting. J Vasc Surg 2012 Dec; 56:1579 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23040713
  11. ↑ 11.0 11.1 Antoniou GA et al Meta-analysis and Meta-Regression Analysis of Outcomes of Carotid Endarterectomy and Stenting in the Elderly. JAMA Surg. Published online October 23, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24154858 <Internet> http://archsurg.jamanetwork.com/article.aspx?articleid=1757343
    Darling RC Carotid Intervention in the Elderly. Who Is Old and Who Benefits? JAMA Surg. Published online October 23, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24154829 <Internet> http://archsurg.jamanetwork.com/article.aspx?articleid=1757342
  12. ↑ 12.0 12.1 Paraskevas KI, Veith FJ. The Indications of Carotid Artery Stenting in Symptomatic Patients May Need To Be Reconsidered. Ann Vasc Surg. 2014 Oct 8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25305422
  13. ↑ Jalbert JJ et al. Outcomes after carotid artery stenting in Medicare beneficiaries, 2005 to 2009. JAMA Neurol 2015 Mar; 72:276. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25580726
  14. ↑ 14.0 14.1 14.2 Howard G et al. Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: A meta-analysis of pooled patient data from four randomised trials. Lancet 2016 Feb 12; PMID: https://www.ncbi.nlm.nih.gov/pubmed/26880122
  15. ↑ Voeks JH, Howard G, Roubin GS et al Age and outcomes after carotid stenting and endarterectomy: the carotid revascularization endarterectomy versus stenting trial. Stroke. 2011 Dec;42(12):3484-90. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21980205 Free PMC Article
  16. ↑ 16.0 16.1 Liang P, Solomon Y, Swerdlow NJ et al. In-hospital outcomes alone underestimate rates of 30-day major adverse events after carotid artery stenting. J Vasc Surg 2020 Apr; 71:1233. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32063441
    Boitano LT, DeCarlo C, Schwartz MR et al. Surgeon specialty significantly affects outcome of asymptomatic patients after carotid endarterectomy. J Vasc Surg 2020 Apr; 71:1242. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31831310
    Edla S, Atti V, Kumar V et al. Comparison of nationwide trends in 30-day readmission rates after carotid artery stenting and carotid endarterectomy. J Vasc Surg 2020 Apr; 71:1222 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31564583
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