Patients with symptomatic stenosis of the internal carotid artery benefit from early intervention. The challenge lies in what intervention to choose. Most studies comparing endarterectomy to carotid stenting are fairly heterogeneous as regards timing of intervention. This element is key to comparing between procedures, since there is no doubt timing will directly affect results. …
Carotid stenting or endarterectomy? considering vascular anatomy…
Complex vascular anatomy could increase the risk of periprocedural stroke during carotid artery stenting (CAS). However, no randomize study has provided evidence showing this potential difficulty should inform the choice between carotid stenting and endarterectomy. This study included 184 patients with symptomatic lesions of the internal carotid randomized to CAS vs. endarterectomy in the context…
Plaque protrusion in carotid artery stenting: what are its risks and how can we prevent them?
Courtesy of Dr. Carlos Fava. Carotid artery stenting (CAS) has proven to be effective in high-risk patients. Nowadays, when performed by trained operators, its results are similar to those of surgery. This study seeks to clarify the incidence and prognosis of plaque protrusion through the stent (as observed in both control angiography and intravascular ultrasound [IVUS])…
Endarterectomy or Carotid Artery Stenting? A Question That Still Generates Studies
There have been several studies offering contradictory data on the relative effectiveness of carotid artery stenting and carotid artery endarterectomy for the prevention of stroke due to carotid artery stenosis. The authors of this study performed a meta-analysis assessing the efficacy of these techniques, given recently published clinical trial data. They selected randomized…
Best Revascularization Strategy for Severe Carotid and Coronary Artery Disease
Courtesy of Dr. Carlos Fava. Carotid artery disease is an important cause of stroke and is associated to coronary artery disease. When patients need myocardial revascularization surgery (Carotid Artery Bypass Graft) and cannot wait one month or more for carotid revascularization, the optimal management strategy is still controversial. The aim of this study was…
Remote Ischemic Preconditioning in Carotid PCI: Safe and Effective?
Remote ischemic preconditioning (RIPC) can prevent recurrent ischemic events in patients with acute or chronic cerebral ischemia. However, is remains unclear whether RIPC could prevent an ischemic event in the context of carotid PCI in patients with severe carotid artery stenosis. The study included patients with severe carotid artery stenosis randomized to RIPC, vs.…
How Important Is Controlling Risk Factors for the Prevention of a Stroke?
There has been a recent decline of about 20% to 40% in the incidence of cerebrovascular accidents (stroke). Although this is attributed to the improvement of risk factor control, the reason behind it is not utterly clear. This study estimated the impact of modifiable cardiovascular risk factors on the incidence of stroke between 1995 and…
Carotid Revascularization After Stroke: When Should It Be Performed?
In 2006, the American Heart Association guidelines recommended that carotid revascularization be performed within 2 weeks of stroke based on data from 2 randomized trials on carotid endarterectomy. This study aimed to determine whether the time between the event and revascularization has decreased after these guidelines were issued, and the proportion of patients receiving some sort of revascularization (endarterectomy…
When to Intervene a Symptomatic Carotid Stenosis?
Guidelines recommend that carotid endarterectomy be performed within two weeks of stroke in patients with symptomatic carotid stenosis. Because a Swedish registry study showed patients treated within the first days after a transient ischemic attack or stroke are at increased risk of death and perioperatory stroke, this study aims at verifying this risk in…
Carotid PCI at Long Term: Effective in Stroke Prevention?
There are no data outside controlled studies, neither are there long term outcomes, on carotid artery stenting. This study was designed to assess the long term effectiveness of carotid stenting to prevent strokes in a large number of real life patients. This registry included prospective data with a strict follow up protocol on 901…
Prevention of Stroke: Carotid Artery Stenting or Endarterectomy?
Original Title: Long-Term Outcome after Carotid Artery Stenting. A Population-Based Matched Cohort Study. Reference: Stroke. 2016 Jul 12. [Epub ahead of print]. In the prevention of stroke, carotid artery stenting (CAS) is far less invasive than endarterectomy, but its long term outcomes remain unclear. This large cohort study compared the long term outcomes of…