Ischemic stroke is the main reason behind disability in the world, and it is often followed by death. The rupture of carotid atherosclerotic plaque and its embolization are the main cause of this entity. Different randomized studies have shown that carotid endarterectomy is beneficial in symptomatic patients with 70 to 99% carotid obstruction, but we…
Symptomatic Carotid Arteries: Early or Late Emergency Revascularization?
Carotid endarterectomy continues to be the safest technique for emergency revascularization. However, 48 hours after index event, different strategy outcomes will become comparable. Multiple advances in device development have brought promising results for carotid revascularization patients with symptomatic stenosis. Regardless these developments, optimal revascularization timing after index event remains unclear. This study included patients with…
Asymptomatic Carotid Lesions and Cognitive Impairment: Does Intervention Play a Role?
This study was designed to determine the effect of carotid endarterectomy/angioplasty on early (baseline vs. 3 months) and late (baseline vs. >5 months) cognitive function in patients with asymptomatic lesions. This systematic research included 31 non-randomized studies. Regarding the immediate post-operative period, 24 of these papers reported significant improvement in cognitive function; one study reported significant deterioration;…
ESC 2021 | ACST-2: CAS vs Endarterectomy in Asymptomatic Patients
The ACST-2 was designed to compare long-term outcomes of carotid artery stenting (CAS) vs carotid endarterectomy (CEA) in patients with asymptomatic stenosis. Prior to this study we had the German registry including 18,000 patients undergoing CAS and 86,000 receiving CEA between 2014 and 2019. At 30 days, disabling stroke rate was 0.7% for both strategies.…
Single or Dual Antiplatelet Therapy in Stroke or Transient Ischemic Attack?
Antiplatelet therapy is key to prevent thrombotic events after a transient ischemic attack (TIA) or ischemic stroke. The role of aspirin is well established in this scenario, but there is emerging evidence for a short period of dual antiplatelet therapy (DAPT). Now, can this strategy avoid recurrent strokes without paying a price in terms of…
Dual Layered for Dual Protection in Carotid PCI
At present, there is more than one dual layered stent in the market offering additional protection in carotid PCI. Therefore we saw fit to look at these devices to compare class benefits and find any specific differences. This study assessed the safety and efficacy of two dual layered mesh covered stents especially designed for carotid…
Do We Need to See a Cardiologist before a Carotid Endarterectomy?
Cardiac complications are among the most frequent in patients undergoing carotid endarterectomy for asymptomatic lesions. This excess of cardiac events in patients with no neurological symptoms of carotid stenosis is essential to balance the risk/benefit ratio of carotid endarterectomy. A routine cardiology consultation prior surgery could reduce perioperative infarction rate, general complications and even mortality. …
Natural History of Severe and Asymptomatic Carotid Lesions
Deciding whether to intervene a severe (70-80%) carotid lesion in an asymptomatic patient is challenging. We know the margin of error is small and an excess of events caused by the intervention could tilt the scales. However, the updated information on the natural evolution of these lesions is scarce. This retrospective analysis included asymptomatic patients…
SOLACI PERIPHERAL | Watch again Carotid Percutaneous Interventions, Where are we? on our Youtube Account
Watch again our Webinar on “Carotid Percutaneous Interventions, Where are we?” on our Youtube account. The event was conducted and organised by the authorities of SOLACI Peripheral, a new Department of SOLACI. We thank the support of Cordis for this event and to all the prestigious panelists that participated in it. We are interested…
Asymptomatic Carotid Artery Stenosis: Do We Have All the Answers?
Advancements in therapies to reduce the impact of stroke in asymptomatic carotid artery stenosis have been hard to come by over the last decade. Several points of disagreement among published randomized trials prevented their information from being integrated into daily clinical practice. However, over the past 5 years, there has been some alignment, allowing for this…
The Whole Toolkit Tested in Carotid Artery Stenting
This study sought to randomly compare the double-layer Roadsaver stent (Terumo) with the single-layer Carotid Wallstent device (Boston) in association with either distal filter-like embolic protection device FilterWire (Boston) or proximal protection device Mo.Ma (Medtronic) in patients with lipid-rich carotid plaques. This is a very interesting work because there are no head-to-head simultaneous comparisons between…