Carotid endarterectomy is the gold-standard treatment for stroke risk reduction in selected patient populations with significant carotid stenosis. Despite the lack of definitive evidence, carotid artery stenting is rapidly emerging as the minimally invasive alternative to carotid endarterectomy. Carotid artery stenting is growing at a yearly rate of 20%. Among the physicians performing this procedure, vascular surgeons are the minority. We describe the evolution of the technique of carotid artery stenting, including the development of cerebral protection devices. The results of retrospective series of carotid artery stenting with protection devices are presented. A review of the ongoing registries and trials evaluating carotid artery stenting is provided. Current indications for carotid artery stenting and a proposed algorithm for the management of carotid stenosis are suggested..
1. Brott T, Bogoussavsky J: Treatmt of acute ischic stroke. N Engl J Med343(10):710-722, 2000.
2.
2. Kistler JP, Buonanno FS, Gress DR: Carotid endarterectomy: Specific therapy based on pathophysiology. N Engl J Med325(7):505-506, 1991.
3.
3. Moore WS, Barnett HJM, Beebe HG, et al: Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the ad hoc committee, American Heart Association. Circulation91(2):566-579, 1995.
4.
4. Wholey MH, Wholey M, Mathias K, et al: Global experience in carotid artery stent placement. Catheter Cardiovasc Interv50:160-167, 2000.
5.
5. Eascott HHG, Pickering GW, Robb CG: Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet2:994-994, 1954.
7. Vanmaele RG, Pickut BA: Reconstructive internal carotid artery surgery over forty years (October 20, 1951-1991). Ann Vasc Surg5(6):564-569, 1991.
8.
8. Easton JD, Sherman DG: Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations. Stroke8(5):565-568, 1977.
9.
9. Chambers BR, Norris JW: The case against surgery for asymptomatic carotid stenosis. Stroke15(6):964-967, 1984.
10.
10. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med325:445-453, 1991.
11.
11. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study: Endarterectomy for asymptomatic carotid stenosis. JAMA (273):1421-1428, 1995.
12.
12. European Carotid Surgery Trialists' Collaborative Group: Medical Research Council European Carotid Surgery Trial: Interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid lesions. Lancet (337):1235-1235, 1991.
13.
13. Perler BA: Carotid endarterectomy: The "gold standard" in the endovascular era. J Am Coll Surg194:S2-S8, 2002.
15. King SB III, Meier B: Interventional treatment of coronary heart disease and peripheral vascular disease. Circulation102:IV-81, 2000.
16.
16. Golledge J, Mitchell A, Greenhalgh RM, et al: Systematic comparison of the early outcome of angioplasty and endarterectomy for symptomatic carotid artery disease. Stroke31(6):1439-1443, 2000.
17.
17. Alberts MJ for the publications committee of the WALLSTENT: Results of a multicenter prospective randomized trial of carotid artery stenting versus carotid endarterectomy [abstract]. Stroke32:325-325, 2001.
18.
18. Naylor AR, Bolia A, Abbott RJ, et al: Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: A stopped trial. J Vasc Surg28:326-334, 1998.
19.
19. CAVATAS Investigators: Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): A randomized study. Lancet357:1729-1737, 2001.
20.
20. Yadav JS, Roubin GS, Lyer S, et al: Elective stenting of the extracranial carotid arteries. Circulation95:376-381, 1997.
21.
21. Jordan WD JR, Voellinger DC, Fischer WS, et al: A comparison of carotid angioplasty with stenting versus endarterectomy with regional anesthesia. J Vasc Surg1998;28:397-403.
22.
22. Diethrich EB, Ndiaye M, Reid DB. Stenting in the carotid artery: Initial experience in 110 patients. J Endovasc Surg3:42-62, 1996.
23.
23. Jordan WD, Schroeder PT, Fisher WS, et al: A comparison of angioplasty vs. endarterectomy in the treatment of carotid artery stenosis. Ann Vasc Surg13:1-8, 1997.
24.
24. Jordan WD, Voellinger DC, Doblar DD, et al: Microemboli detected by transcranial Doppler monitoring in patients during carotid angioplasty versus carotid endarterectomy. Cardiovasc Surg7:33-38, 1999.
25.
25. Ohki T, Marin M, Lyon RT, et al: Ex vivo human carotid artery bifurcation stenting: correlation of lesion characteristics with embolic potential. Vasc Surg27:463-471, 1998.
26.
26. Theron JG, Courtheowx P, Alachkar F, et al: New triple coaxial catheter system for carotid angioplasty with cerebral protection. Am J Neuroradiol11:869-874, 1990.
27.
27. Al-Mubarak N, Roubin GS, Vitek JJ, et al: Microembolization during carotid stenting with the distal-balloon antiemboli system. Int Angiol21(4):344-348, 2002.
28.
28. Henry M, Amor M, Henry I, et al: Carotid stenting with cerebral protection: first clinical experience using the PercuSurge GuardWire system. J Endovasc Surg6(4):321-331, 1999.
29.
29. Tubler T, Schluter M, Dirsch O, et al: Balloon-protected carotid artery stenting: Relationship of periprocedural neurological complications with the size of particulate debris. Circulation104(23):2791-2796, 2001.
30.
30. Dietz A, Berkefeld J, Theron JG, et al: Endovascular treatment of symptomatic carotid stenosis using stent placement: Long-term follow-up of patients with a balanced surgical risk/benefit ratio. Stroke32(8):1855-1859, 2001.
31.
31. d'Audiffret A, Desgranges P, Kobeiter H, et al: Technical aspects and current results of carotid stenting. J Vasc Surg33(5):1001-1007, 2001.
32.
32. Al-Mubarak N, Roubin GS, Vitek JJ, et al: Effect of the distal-balloon protection system on microembolization during carotid stenting. Circulation104(17):1999-2002, 2001.
33.
33. Whitlow PL, Lylyk P, Londero H, et al: Carotid artery stenting protected with an emboli containment system. Stroke33(5):1308-1314, 2002.
34.
34. Criado FJ, Lingelbach JM, Ledesma DF, et al: Carotid artery stenting in a vascular surgery practice. J Vasc Surg35(3):430-434, 2002.
35.
35. Macdonald S, Venables GS, Cleveland TJ, et al: Protected carotid stenting: Safety and efficacy of the MedNova NeuroShield filter. J Vasc Surg35:966-972, 2002.
36.
36. Al-Mubarak N, Colombo A, Gaines PA, et al: Multicenter evaluation of carotid artery stenting with a filter protection system. J Am Coll Cardiol39(5):841-846, 2002.
37.
37. Hobson RW 2nd, Lal BK, Chaktoura E, et al: Carotid artery stenting: Analysis of data for 105 patients at high risk. J Vasc Surg37(6):1234-1239, 2003.
38.
38. Henry M, Henry I, Polydorou A, et al: Carotid artery angioplasty: What have we learned with a series of 552 procedures. Am J Cardiol90(suppl 6A):55H-55H, 2002.
39.
39. Roubin GS, Hobson RW, White R, et al: CREST and CARESS to evaluate carotid stenting: Time to get to work!J Endovasc Ther8: 107-110, 2001.
40.
40. Ouriel K, Yadav JS, Wholey M, et al: The SAPHIRE randomized trial of carotid stenting versus endarterectomy: A subgroup analysis. Vascular Annual Meeting 2003, Chicago, IL, June 8-11, 2003. Scientific Program 2003, pp 88-89.
41.
41. Baker WH, Hayes AC, Mahler D, et al: Durability of carotid endarterectomy. Surgery94(1):112-115, 1983.
42.
42. Mayberg MR, Wilson SE, Yatsu F, et al for the Veterans Affairs Cooperative Studies Program 309 Trialist Group: Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. JAMA266:3289-3289, 1991.
43.
43. Mansour MA, Kang SS, Baker WH, et al: Carotid endarterectomy for recurrent stenosis. J Vasc Surg25(5):877-883, 1997.
44.
44. Gasparis AP, Ricotta L, Cuadra SA, et al: High-risk carotid endarterectomy: Fact or fiction. J Vasc Surg37(1):40-46, 2003.
45.
45. Harbaugh RE, Magnadottir HB. Carotid endarterectomy in high-risk patients. Neurol Res24(Suppl 1):S66-S70, 2002.
46.
46. O'Hara PJ, Hertzer NR, Mascha EJ, et al: Carotid endarterectomy in octogenarians: Early results and late outcome. J Vasc Surg27: 860-869, 1998.
47.
47. Jordan WD Jr, Alcocer F, Wirthlin DJ, et al: High-risk carotid endarterectomy: challenges for carotid stent protocols. J Vasc Surg35:16-22, 2002.
48.
48. Lepore MR, Sternbergh C, Salartash K, et al: Influence of NASCET/ACAS trial eligibility on outcome after carotid endarterectomy. J Vasc Surg34581-586, 2001
49.
49. Mansour MA, Littooy FN, Watson WC, et al: Outcome of moderate carotid artery stenosis in patients who are asymptomatic. J Vasc Surg29(2):217-225, 1999.
50.
50. Erzurum VZ, Littooy FN, Steffen G, et al: Outcome of nonoperative management of asymptomatic highgrade carotid stenosis. J Vasc Surg36(4):663-667, 2002.
