Extracranial carotid artery disease represents 15 to 20% of all strokes. Carotid revascularization plays a role in primary and secondary prevention of cerebrovascular events. Outcomes of two common revascularization strategies, Carotid endarterectomy (CAE) and carotid artery stenting (CAS), have been studied and compared. In recent years, complications associated to CAS have dropped thanks to technical…
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.…
Contralateral Occluded Carotid Defines Revascularization Strategy
A significative lesion to the carotid artery in addition to contralateral carotid occlusion is an obvious factor of high risk for a revascularization procedure. However, this might be true for surgery but not for carotid artery stenting according to this recent publication in JACC. The presence of contralateral carotid occlusion has been established as high…
Watch again the 7° ProEducar Educational Meeting on Extracardiac Interventions
Watch again the 7° ProEducar Educational Meeting on Extracardiac Interventions on our Youtube channel. In this video you will learn about: How to perform a carotid angioplasty and avoid complications? Educational Case. Step by Step – Dr. Estêvão Carvalho de Campos Martins (BRA). ntervention in lower limbs critical ischemia – Dr. Larry Díaz Sandoval (USA).
7° ProEducar Educational Meeting – Extracardiac Intervention
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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…
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…
New Device for More Protection in Carotid Artery Stenting
This new “Paladin” system for post-dilation during carotid artery stenting was safe and may effectively reduce the number of particles that reach the brain, with a subsequent decreased risk for peri-procedural stroke. This study evaluated the safety and efficacy of the Paladin System, a novel post-dilation balloon with an integrated distal protection filter designed to…
Paladin: New Carotid Protection System with Good Results
Courtesy of Dr. Carlos Fava. Carotid artery stenting (CAS) with a cerebral protection system has emerged as an alternative to surgery, particularly for patients with high surgical risk. Nowadays, there are a considerable number of cerebral protection systems, but these may sometimes fail due to anatomical issues, the diameter of embolized particles, or placement difficulties (among…
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