Protected Carotid Stenting in High-Risk Patients With Severe Carotid Artery Stenosis

Abstract

For some patients with severe carotid stenosis and high-risk features for carotid endarterectomy, carotid artery stenting with distal embolic protection is a reasonable alternative for revascularization.

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…[245][246][247][248][249][250][251] If properly deployed, an EPD can reduce the neurological risks associated with CAS, but these devices may also be associated with failures. 53,196,198,247,[252][253][254][255][256][257][258] Among the general risks is access-site injury, which complicates 5% of cases, but most such injuries involve pain and hematoma formation and are self-limited. [259][260][261][262] Contrast-induced nephropathy has been reported in <1% of cases, because CAS is generally avoided in patients with severe renal dysfunction.…”

Effects of Age and Symptom Status on Silent Ischemic Lesions after Carotid Stenting with and without the Use of Distal Filter Devices

“…1,2 In the past few years, however, carotid angioplasty and stent placement (CAS) has emerged as an alternative endovascular treatment strategy for these disorders. Although initial single-center case series and registries have reported acceptable periprocedural complication rates after CAS even in surgical high-risk patients, [3][4][5][6] recent randomized trials directly comparing CAS with CEA have produced conflicting results. [7][8][9] Compared with surgery, CAS potentially has the major disadvantage of producing more emboli to the brain, 10 which has led to the development and widespread application of cerebral protection devices aimed at preventing the passage of embolic material into the cerebral vasculature.…”

Cerebral Hyperperfusion Syndrome After Angioplasty

“…Strict control of hypertension is one of the preventive measures that has received the most attention. Most Investigators recommend strict control of BP in the postoperative period to prevent ICH after CEA (Ahn et al, 1989;Bernstein et al, 1984;Bove et al, 1979;Buhk et al, 2006;Hosoda et al, 2001;Ko et al, 2005;Roh et al, 2005;Safian et al, 2006;Tang et al, 2008) and after CAS, as we will see below. It has been suggested that even BP in the normal range may be deleterious in patients at high risk for CHS (Piepgras et al, 1988;Ouriel et al, 1999;Jorgensen & Schroeder, 1993).…”