Transcatheter intervention in carotid artery disease: when and how?

Abstract

In general population, in 5.7% of patients between 70 and 80 years of age and 9.5% of patients over 80 years of age, carotid stenosis over 50% is diagnosed. Carotid stenosis can be asymptomatic or diagnosed when TIA (transient ischemic attack) or cerebral stroke occurs (symptomatic). In patients with symptomatic carotid stenosis, the risk of recurrent stroke is much higher. Carotid stenosis could be easily and promptly diagnosed with Doppler ultrasound, CT scan or MR imaging. The degree of stenosis, morphology and homogeneity of adjacent plaque, presence of thrombus, intracranial pathologies and asymptomatic cerebral embolic events must be evaluated. Optimal medical treatment has to be provided to patients, both with symptomatic and asymptomatic carotid stenosis. Antiplatelet and statin therapy should be administered to all patients, irrespective of symptoms or disease progression. Risk factors (arterial hypertension, diabetes, obesity, smoking etc.) must be recognized and promptly cured. Although many large scale trials (CAVATAS, EVA-3S, ICSS, SAPPHIRE, CREST, etc.) recognize carotid endarterectomy advantages in the treatment of carotid stenosis, carotid stenting as a revascularization option has its place in certain subgroups of patients. The patients with high perioperative risk, infavourable neck anatomy, prior neck dissection, restenosis after carotid endarterectomy or post-irradiation stenosis benefit from transcatheter interventions. The aim of this research is to explore the indications and to detail the most used techniques in carotid artery stenosis transcatheter interventions.