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Vascular surgeons ask, what's next for carotid artery stenting?
January 17, 2008A procedure called carotid artery stenting (CAS) has emerged as a minimally invasive alternative to surgery, called carotid endarterectomy (CEA), for patients with dangerous narrowing of the arteries supplying blood to the brain. However, questions remain about the best uses of this procedure-especially whether it is an appropriate alternative to surgery for "low-risk" patients, according to a special article in the January/February issue of Annals of Vascular Surgery.
"Currently, the choice of CEA versus CAS in individual patients is based more on individual practitioner experience than on clear evidence-derived guidelines," according to the new article by Drs. Philip P. Goodney and Richard J. Powell of Dartmouth-Hitchcock Medical Center, Lebanon, N.H. "Nonetheless, the popularity of less-invasive therapy combined with marketing of new CAS systems has increased the utilization of CAS."
Drs. Goodney and Powell review and summarize the research evidence on CAS to prevent stroke in patients with narrowing (stenosis) of the carotid arteries. In the CAS procedure, an expandable mesh device called a stent is placed to increase blood flow through the area of stenosis.
Recently, several randomized controlled trials-the strongest category of scientific evidence-have directly compared the results of CAS and CEA. It has now been fairly well established that CAS and CEA yield comparable results in "high-risk" patients.
However, debate continues as to the role of CAS in the much larger group of "low-risk" patients. Some studies suggest that CAS and CEA produce similar results, but others have found a lower rate of serious complications and death in patients undergoing surgery.
Drs. Goodney and Powell note several limitations of the research that make it difficult to compare results between trials. Studies being conducted now will help to clarify the relative performance of the two techniques in both high-risk and low-risk patients. A key question will be whether CAS or CEA is the better choice for patients considered high-risk because of medical conditions.
Other issues that will need to be worked through include refinements in the design of CAS systems and the role of detailed imaging studies in guiding treatment decisions. "Ongoing randomized trials will help determine optimal revascularization strategies in the future," the authors conclude.
Elsevier
Recently, several randomized controlled trials-the strongest category of scientific evidence-have directly compared the results of CAS and CEA. It has now been fairly well established that CAS and CEA yield comparable results in "high-risk" patients.
However, debate continues as to the role of CAS in the much larger group of "low-risk" patients. Some studies suggest that CAS and CEA produce similar results, but others have found a lower rate of serious complications and death in patients undergoing surgery.
Drs. Goodney and Powell note several limitations of the research that make it difficult to compare results between trials. Studies being conducted now will help to clarify the relative performance of the two techniques in both high-risk and low-risk patients. A key question will be whether CAS or CEA is the better choice for patients considered high-risk because of medical conditions.
Other issues that will need to be worked through include refinements in the design of CAS systems and the role of detailed imaging studies in guiding treatment decisions. "Ongoing randomized trials will help determine optimal revascularization strategies in the future," the authors conclude.
Elsevier
Carotid Artery Stenting Current Events and Carotid Artery Stenting News RSSStudy reveals embolic neuroprotection system reduces risk of cardiac events
Results of a study on the use of the FiberNet® Embolic Protection System in carotid artery stenting were reported today during the 20th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation (CRF).
SAPPHIRE trial shows long-term benefit of carotid stenting as alternative to surgery
Carotid artery stenting is an effective option for high risk patients who are not eligible for surgery, according to a long-term study published in this week's New England Journal of Medicine. Carotid artery disease, which involves clogging of the arteries in the neck that provide blood to the brain, is a significant risk factor for stroke, making these study results important for the estimated 200,000 Americans each year who would otherwise not be candidates for the treatment.
Research sheds light on carotid artery stenting risk in elderly
Dr. Hernan Bazan, Assistant Professor of Surgery, Section of Vascular Surgery, at Louisiana State University Health Sciences Center New Orleans' School of Medicine, is the lead author of a research paper which may help physicians decide which patients with carotid artery occlusive disease should have carotid surgery or carotid stenting.
2 carotid artery stenting studies show results comparable to AHA guidelines
Two carotid stenting trials examining patient outcomes demonstrated results that are comparable to guidelines established by the American Heart Association (AHA) for patients treated with carotid artery surgery.
Cerebral embolic protection and carotid stent systems
High-risk surgical patients in community hospital settings can safely benefit from the use of new embolus-removing and stent-inserting systems, according to a study presented today at the American College of Cardiology's Innovation in Intervention: i2 Summit in New Orleans, La.
Three-year SAPPHIRE and US carotid feasibility trials demonstrate durability of carotid stenting
Preliminary three-year data from the SAPPHIRE and final three-year data from the U.S. Carotid Feasibility Study (USFS) presented at the 2005 Transcatheter Cardiovascular Therapeutics meeting, demonstrate the long-term durability of carotid artery stenting (CAS) for the prevention of stroke versus carotid endarterectomy (CEA) in high risk surgical patients.
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Carotid Artery Stenting: The Basics (Contemporary Cardiology) by Jacqueline Saw (Editor) Over the past three decades, carotid artery stenting has evolved to become a promising and viable alternative to carotid endarterectomy, especially for patients deemed to have high surgical risks. In Carotid Artery Stenting: The Basics, Jacqueline Saw and a panel of international experts on carotid artery stenting discuss in depth the details of all contemporary aspects of carotid stenting, while reviewing supporting studies, guidelines, technical perspectives, and peri-procedural management. This textbook serves as a learning resource on the multifaceted management of patients with carotid artery stenosis, with the key focus on extracranial carotid artery stenting. Additional sections detail the specifics of setting up and maintaining a laboratory and discuss the preparation of the... |
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Early and late outcomes of carotid artery stenting/Karotis arter stentlerinin erken ve gec sonuclari.(Original Investigation/Orijinal Arastirma)(Table)(Clinical ... of Cardiology (Anadolu Kardiyoloji Dergisi) by Omer Aydiner (Author), Bilal Boztosun (Author), Mustafa Sirvanci (Author), Mustafa Akcakoyun (Author), Kutlay Karaman (Author), Tamer Aksoy (Author), Levent Onat (Author) This digital document is an article from The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi), published by Thomson Gale on June 1, 2007. The length of the article is 4268 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser. Citation Details Title: Early and late outcomes of carotid artery stenting/Karotis arter stentlerinin erken ve gec sonuclari.(Original Investigation/Orijinal Arastirma)(Table)(Clinical report) Author: Omer Aydiner Publication: The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi) (Magazine/Journal) Date: June 1, 2007 Publisher: Thomson... | |
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