Endovascular treatment of carotid artery stenosis: retrospective study of 79 patients treated with stenting and angioplasty with and without cerebral protection devices

Kihara, Eduardo Noda; Andrioli, Mario Sergio Duarte; Zukerman, Eliova; Peres, Mário Fernando Prieto; Júnior, Pedro Paulo Porto; Monzillo, Paulo Hélio; Okamoto, Ivan Hideyo; Massaro, Ayrton Roberto; Zirretta, José Carlos

doi:10.1590/s0004-282x2004000600015

Cited by 9 publications

(5 citation statements)

References 22 publications

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“…[27][28][29][30][31][32][33] This statement, however, is supported essentially by case series, some quite large but probably not bias-free. 34 Additional information should also be obtained from the ongoing studies, although they are not randomized as to the application of cerebral protection devices or techniques.…”

Section: Recommendation 6: Grade D [B]mentioning

confidence: 99%

Carotid Artery Stenting

Cremonesi

Setacci²,

Bignamini

et al. 2006

Stroke

101

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Background and Purpose-The prevention of stroke and the correct treatment of carotid artery stenosis represent today a major debate in cardiovascular medicine. Beside carotid endarterectomy, carotid angioplasty and stenting is becoming more widely performed for the treatment of severe carotid obstructive disease, and is now accepted as a less invasive technique that may provide an alternative for selected patients, particularly those with significant comorbidities. An Italian multidisciplinary task force, in which converged the most representative scientific societies involved in carotid treatment, was created to provide neurologists, radiologist, cardiologists, vascular surgeons, and all those involved in prevention and treatment of carotid disease with a simple, clear and updated evidence-based consensus document. Summary of Review-This First Consensus Document of the ICCS (Italian Consensus Carotid Stenting)/SPREAD groupaddressed the main issues related to methodology, definition of symptomatic and asymptomatic carotid stenosis, indication and procedures for carotid artery stenting, including the use of devices for preventing procedural embolic complications. Special attention was paid to credentials and competency for physicians qualifications to perform vascular angioplasty and stent placement, including training, acceptable complication rates and certification. Conclusions-As any guideline or consensus statement, also this document is valid as long as the evidence on which it is based remains up-to-date. In such a fast-evolving field of medicine as the management of carotid stenosis, it is mandatory to stimulate a continuous and fruitful discussion among all the professionals involved in this very evolutionary field. (Stroke. 2006;37:2400-2409.)Key Words: carotid stenosis Ⅲ consensus statement T he problems associated with the treatment of carotid atherosclerotic disease today represent a major matter of debate in cardiovascular medicine. In the first part of 2005, the Italian Society of Interventional Cardiology (SICI-GISE, http://www.gise.it) appointed a special task force to address this subject. This multidisciplinary working group represents a convergence of delegates designated by the representative scientific societies involved in carotid treatment: (1) SICI-GISE, Italian Society of Interventional Cardiology; (2) SIC, Italian Society of Cardiology; (3) ANMCO, National Association of Hospital Cardiologists; (4) AINR, National Association of Neuroradiology; (5) SICVE, Italian Society of Vascular and Endovascular Surgery; (6) SIN, Italian Society of Neurology; and (7) SIRM, Italian Society of Medical Radiology.The task force also included several members of the SPREAD group, a multidisciplinary association representing Ͼ30 scientific societies and patient organizations in the field of cardiovascular disease, which, during the last 7 years, has released 4 editions of evidence-based guidelines for stroke prevention and treatment (http://www.spread.it).The SICI-GISE and SPREAD groups decided to combine th...

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Section: Recommendation 6: Grade D [B]mentioning

confidence: 99%

Carotid Artery Stenting

Cremonesi

Setacci²,

Bignamini

et al. 2006

Stroke

101

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“…Cerebral protection and relevant devices, the type of stenting, and the ultrasonography/imaging profile of the stenosis and plaque are all issues deserving adequate discussion, although until now no positions, except those on cerebral protection, are sufficiently supported by the evidence. On this point, current evidence supports the notion that stenting procedures are less prone to periprocedural risks when adequate cerebral protection is applied with a device the interventionist is familiar with and is an expert trained well in its use[46,47,48,49,50,51]. However, this statement is supported essentially by case series, some of which are quite large but probably not bias free [52].…”

Section: Cas: Acceptable Complication Rates and Risk Certificationmentioning

confidence: 84%

Carotid Artery Stenting: Second Consensus Document of the ICCS/ISO-SPREAD Joint Committee

et al. 2014

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Background: A major debate in cerebrovascular medicine today is over the choice of the best treatment to implement for stenosis of the carotid artery. Carotid artery stenting is a less invasive technique than endarterectomy for the treatment of carotid stenosis, and is becoming more widely performed, particularly on patients with carotid artery stenosis who present also with comorbidities. To address the aspects related to the use of carotid artery stenting, an Italian multidisciplinary task force comprising the most representative scientific societies concerned with carotid artery disease was set up to provide neurologists, radiologists, cardiologists, vascular surgeons, and all those involved in stroke prevention and treatment with an updated, evidence-based consensus document. Summary: The task force followed a structured methodology to assess the literature on carotid stenosis in order to provide a summary of the main issues related to carotid artery stenting, including the definition of the grade of symptomatic carotid artery stenosis, indications for intervening on the carotid artery stenosis, establishing whether to perform either a surgical or an endovascular procedure, the training, credentialization, and competency needed by physicians to perform carotid artery stenting, acceptable complication rates and risk certification for carotid artery stenting, management of stented patients, durability of carotid artery stenting, and future tasks. Here, we outline the main findings of this effort. Key Messages: As for any guideline or consensus statement, each point is valid as long as the evidence on which it is based remains up to date. In a fast-evolving field of medicine such as that of carotid artery stenosis management, and in particular carotid artery stenting, the stimulation of continuous and fruitful discussion among all professionals involved is mandatory. We hope that this document may provide a standardized basis for the application of carotid artery stenting as implemented today.

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“…Protection devices appear to play a role in avoiding this problem. [37,38] Lack of cerebral protection, poor patient selection and the relatively small size of the series adversely affected the result. The stroke recurrence rate was 2.04%, which was significantly low when compared to the natural history of the patients with atherosclerotic carotid artery disease which can be as high as 26.5%.…”

Section: Discussionmentioning

confidence: 99%