Editorial

Is It Time for Carotid Artery Stenting in Low-Risk Patients?

Authors: Jon C. George, MD

Abstract

Carotid artery stenting (CAS) has been increasingly adopted as a less invasive endovascular option of carotid revascularization in varied clinical populations. The SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy) trial1 first demonstrated the superiority of CAS using embolic protection devices over carotid endarterectomy (CEA) in high-risk patients. More recently, CREST (Carotid Revascularization Endarterectomy versus Stenting Trial)2 confirmed that there is clinical equivalence between CAS and CEA in average-risk patients. We now await the next CAS study that should intuitively focus on low-risk patients.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004;351:1493-1501.
 
2. Brott TG, Hobson RW 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid artery stenosis. N Engl J Med 2010;363:11-23.
 
3. White CJ, Beckman JA, Cambria RP, et al. Atherosclerotic Peripheral Vascular Disease Symposium II: controversies in carotid artery revascularization. Circulation 2008;118:2852-2859.
 
4. Meyer F, Piepgras D, Fode N. Recurrent carotid stenosis. In: Meyer FB, ed: Sundt's Occlusive Cerebrovascular Disease. Philadelphia, PA, WB Saunders, 1994:310-321.
 
5. Gasecki AP, Eliasziw M, Ferguson GG, et al. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. J Neurosurg 1995;83:778-782.
 
6. Rothwell PM, Warlow CP. Prediction of benefit from carotid endarterectomy in individual patients: a risk-modeling study. Lancet 1999;353:2105-2110.
 
7. Macdonald S, Lee R, Williams R, et al. Towards safer carotid artery stenting: a scoring system for anatomic suitability. Stroke 2009;40:1698-1703.
 
8. Garg N, Karagiorgos N, Pislimisis GT, et al. Cerebral protection devices reduce periprocedural strokes during carotid angioplasty and stenting: a systematic review of the current literature. J Endovasc Ther 2009;16:412-427.
 
9. Casserly IP, Abou-Chebl A, Fathi RB, et al. Slow-flow phenomenon during carotid artery intervention with embolic protection devices. J Am Coll Cardiol 2005;46:1466-1472.
 
10. Stabile E, Salemme L, Sorrropago G, et al. Proximal endovascular occlusion for carotid artery stenting: results from a prospective registry of 1300 patients. J Am Coll Cardiol 2010;55:1661-1667.
 
11. George JC, White CJ. Carotid artery stenting: lessons from CREST (Carotid Revascularization Endarterectomy versus Stenting Trial). JACC Cardiovasc Interv 2010;3:988-990.
 
12. Kumar PV, Lakshmi A, Shrivastava R, et al. Protected carotid artery stenting in patients at high risk for carotid endarterectomy. South Med J 2011;104:257-263.