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|Year : 2019 | Volume
| Issue : 6 | Page : 1429-1430
Carotid Artery Stenting in Occlusive Carotid Artery Disease: An Appraisal
Suyash Singh, Kamlesh Singh Bhaisora, Kuntal Kanti Das
Department of Neurosurgery and Apex Trauma Center, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
|Date of Web Publication||20-Dec-2019|
Dr. Kamlesh Singh Bhaisora
Department of Neurosurgery and Apex Trauma Center, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh S, Bhaisora KS, Das KK. Carotid Artery Stenting in Occlusive Carotid Artery Disease: An Appraisal. Neurol India 2019;67:1429-30
The treatment of carotid artery stenosis disease has evolved over the last few decades, and the resultant controversies regarding the best management have culminated in a plethora of more studies. These studies have concluded that carotid artery stenting (CAS) and carotid endarterectomy (CEA) were comparable treatment options for both symptomatic and asymptomatic carotid stenosis disease albeit with higher periprocedural stroke risk in CAS. Altibi et al., in the study in focus, studied the relation between periprocedural strokes and the 30-day mortality in patients of carotid artery stenosis undergoing CAS. They found that the occurrence of strokes after CAS increased 30-day mortality significantly. This important clinical issue, which had surprisingly gone unreported before, was a major highlight of this study.
Carotid stenosis leads to nearly 20% of all strokes in adults. The treatment for atherosclerotic carotid disease has evolved significantly since the 1950s. Various trials done in the early 1990s have proven the role of CEA vis-à-vis the best medical management. However, medical treatment has also improved significantly since then. First, endovascular angioplasty for carotid stenosis was done in 1970 and ever since, with advancements in the technology of endovascular treatment, CAS has become one of the leading modalities of treatment for carotid stenosis disease. In the early twenty- first century, carotid revascularization endarterectomy versus stenting trial (CREST) concluded that CAS and CEA were comparable treatment options for both symptomatic and asymptomatic carotid stenotic diseases. Still CAS had significantly more risks of periprocedural stroke.
Voeks et al. found similar findings while comparing two different procedures for CAS. The CREST also showed increased periprocedural complications with CAS in the elderly population.
The conclusion by Albiti et al. that periprocedural strokes in CAS increased the risks of 30 days mortality can be an exaggeration in the present scenario, with the advancements in hardware in the endovascular armamentarium, particularly, the availability of various protection devices, seldom used in the earlier studies. In addition, given the fact that this meta-analysis included all retrospective studies until date, this association may not be that relevant in the present times. The cause of stroke in CAS may be hemodynamic insufficiency secondary to the temporary occlusion of flow during the procedure or ischemia because of the dislodgment of embolus during the procedure. The risk of hemodynamic strokes can be there in both the procedures, namely, CEA and CAS. With the widespread use of newer protection devices, this risk of embolic stroke has markedly reduced in CAS, if not completely abolished.
To conclude, CEA and CAS are well-established modalities of treatment for carotid artery disease, as suggested by the large body of literature. The literature has clearly shown that CEA is the best management option for carotid artery stenosis in low surgical risk patients, while it is preferable to go for CAS in high surgical risk patients. We have all the reasons to believe so until compelling new evidence proves otherwise.
| » References|| |
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