Carotid Artery Stenting With Patient- and Lesion-Tailored Selection of the Neuroprotection System and Stent Type:Early and 5-Year Results From a Prospective Academic Registry of 535 Consecutive Procedures (TARGET-CAS)

Abstract

Tailored CAS is associated with a low complication rate and high long-term efficacy. CAS operators should have a practical knowledge of different NPDs, including at least one proximal type.

Carotid Revascularization Using Endarterectomy or Stenting Systems (CaRESS):4-Year Outcomes

“…10,11 Both the 30-day and 1-year results of the CaRESS trial showed no difference in outcome between carotid CEA and CAS with distal cerebral protection: both had 2% 30-day combined stroke/death rates. 12,13 During the 8 years since CaRESS was conceived, the techniques and devices for CAS have evolved considerably, 14-17 yet reimbursement has remained available for only high-risk patients. Moreover, the aging population has presented new treatment challenges.…”

Safety and efficacy of endovascular treatment for carotid artery stenoses using proximal protection systems: 30-day follow-up

“…Prevalence of ischaemic cerebral events during 30-day follow-up reported by randomised trials, with different types of DSP utilised, was at the level of 4% in asymptomatic patients, and even as high as 10% in symptomatic individuals [5][6][7][8][9]. By contrast, open-label studies when also a proximal protection has been applied (such a system was used in approximately 30% of procedures) reported much lower rates of adverse events: 0.9-2.4% of death or stroke [10][11][12][13]. There is a growing body of evidence supporting the use of PPS during CAS.…”

“…Other researchers found that complications were associated with bilateral carotid disease, long lesions, advanced patient's age and a history of myocardial infarction [10,11,[13][14][15][16]. Data revealed by large-scale registries on endovascular carotid interventions suggest that because of a risk of cerebral embolisation, the use of protection system during CAS is warranted [10,11,17,18].…”

“…Most of published papers on CAS deal with distal protection systems (DPS) [5][6][7][8][9]. Still, it is believed that proximal protection systems (PPS) in terms of their safety and efficacy have potential advantage over distal ones, yet evidence of such superiority remains to be documented [10][11][12][13].…”

The CREST study shows a definite role for carotid artery stenting

“…Użycie techniki doboru urządzenia protekcyjnego i typu stentu do morfologii blaszki miaż-dżycowej i anatomii tętnic szyjnych, tzw. tailored CAS, pozwala jeszcze bardziej zmniejszyć częstość powikłań okołozabiegowych -do 1,5-2,2% [10,11]. Zastosowanie systemów proksymalnej protekcji (ciągle jeszcze niestosowanej powszechnie w USA) oraz użycie stentów hybrydowych lub zamkniętokomórkowych w takim badaniu jak CREST raz na zawsze rozwiałoby wątpliwości co do wielkich korzyści, jakie przynoszą techniki endowaskularne w profilaktyce pierwotnej i wtórnej udarów mózgu.…”