Carotid Angioplasty and Stenting

The feasibility and safety of percutaneous carotid angioplasty and primary stenting has become a popular topic of debate among vascular and endovascular surgeons. The North American symptomatic carotid endarterectomy trial (NASCET) demonstrated the superiority of endarterectomy over medical management of symptomatic 70% carotid stenosis. In NASCET, the risk of post-operative stroke or death was 5.8%. In high risk patients with significant coronary artery disease, morbidity and mortality rates as high as 18% have been reported. Cranial nerve palsies occur in approximately 7.6%. Restenosis (50%) after endarterectomy appears to be between 5% and 19%. The asymptomatic carotid atherosclerosis study (ACAS) showed a statistically significant reduction in stroke incidence after carotid endarterectomy in asymptomatic carotid stenosis of 60%. In ACAS there was a 2.3 incidence of peri-operative stroke or death.

Studies have demonstrated an incidence of stroke and death of 7.9% with cartoid stenting. Major stroke or death was 2.4% and minor stroke was 5.5%. Minor stroke was defined as a stroke with functional recovery within seven days. 85% of the vessels in some studies remained patent during a mean follow-up period of 27 months.

In a high-risk population of patients, percutaneous carotid angioplasty and stenting can be performed effectively with low re-stenosis and repeat intervention rates.