Carotid artery stenting: an update

Abstract

In patients with carotid disease, the purpose of carotid artery revascularization is stroke prevention. For >50 years, carotid endarterectomy has been considered the standard treatment for severe asymptomatic and symptomatic carotid stenoses. Carotid artery stenting (CAS) has emerged in the last 15 years as minimally invasive alternative to surgery. However, the value of the endovascular approach in the management of carotid disease patients remains highly controversial. The aims of this review are to elucidate the current role of CAS, to describe the major technology advancements in the field, and to speculate about the future of this therapy.

Safety of Slender 5Fr Transradial Approach for Carotid Artery Stenting With a Novel Nitinol Double-Layer Micromesh Stent

“…12 The issue of embolic protection remains controversial. 17 Although we have shown that distal and Mo-Ma embolic protection devices can be used for carotid stenting by radial approach, it is possible that the unique double-layer micromesh design of these stents may obviate the need for systematic embolic protection. Indeed, this design provides excellent wall apposition even in tortuous anatomies, and the micromesh architecture specifically prevents atherosclerotic plaque protrusion and distal embolization after stent deployment.…”

The Casper carotid artery stent: a unique all metal micromesh stent designed to prevent embolic release

“…The ability to re-sheath and reposition the stent is unique with this device and provided added comfort and confidence for the operator. Other dual layer micromesh carotid stents involved in clinical trials utilized extended polytetrafluoroethylene with nitinol (WL Gore)8 9 and polyethylene terephthalate with nitinol (InspireMD)9 10 in their dual layer construction in contrast with the all nitinol Casper stent.…”

Carotid artery stenting

“…The outcomes of large-scale registries (ie, enrolling over 1000 patients) have been recently summarised 24. Those registries have included over 23 000 patients and the use of EPD was mandatory in the majority of them.…”