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Recent Advances in Carotid Artery Stenting

  • Roberto Nerla
  • Kumara Ganesan
  • Antonio Micari
  • Fausto Castriota
  • Alberto Cremonesi
Chapter

Abstract

Carotid artery stenting (CAS), which has emerged as an alternative therapy to high-risk surgical patients, has become an increasingly important procedure in the optimal management of patients with carotid disease. Current evidence both in symptomatic and in asymptomatic patients suggests that CAS should be performed by skilled operators with formal training and in high-volume centers with a standardized and tailored approach.

A proper tailored approach is based on a profound knowledge of available devices and has been emphasized as the key to achieving a safe practice. Emerging technologies and further innovations pursuing stroke prevention are having wider application and their clinical impact is starting to be evaluated. However, technology advancements must be considered as adjunctive tools in a careful procedural strategy possibly including preprocedural evaluation of CAS technical risks, use of cerebral protection devices, stent selection, and proper management of CAS complications. Following this approach, CAS is intended to be at least as safe and effective as surgical endarterectomy.

References

  1. 1.
    Robertson JT. Carotid endarterectomy: a Saga of clinical science, personalities, and evolving technology. Willis Lect Stroke. 1998;29:2435–41.CrossRefGoogle Scholar
  2. 2.
    Roubin GS, Iyer S, Halkin A, Vitek J, Brennan C. Realizing the potential of carotid artery stenting proposed paradigms for patient selection and procedural technique. Circulation. 2006;113:2021–30.CrossRefPubMedGoogle Scholar
  3. 3.
    Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The heart outcomes prevention evaluation study investigators. N Engl J Med. 2000;342:145–53.CrossRefPubMedGoogle Scholar
  4. 4.
    Collins R, Armitage J, Parish S, et al.; Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk condi-tions. Lancet. 2004;363:757–67.Google Scholar
  5. 5.
    Halliday A, Mansfield A, Marro J, et al.; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: ran-domised controlled trial. Lancet. 2004;363:1491–502.Google Scholar
  6. 6.
    Yadav JS, Wholey MH, Kuntz RE, et al.; Stenting and Angioplasty with Protection in Patients at High Risk for Endarterecto-my Investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493–501.Google Scholar
  7. 7.
    Mas JL, Chatellier G, Beyssen B, et al.; EVA-3S Investigators. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660–71.Google Scholar
  8. 8.
    Mas JL, Trinquart L, Leys D, et al.; EVA-3S Investigators. Endarterectomy versus angioplasty in patients with symptomatic severe carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol. 2008;7:885–92.Google Scholar
  9. 9.
    Ringleb PA, Allenberg J, Brückmann H, et al.; SPACE Collaborative Group. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006;368:1239–47.Google Scholar
  10. 10.
    Ederle J, Dobson J, Featherstone RL, et al.; International Carotid Stenting Study investigators. Carotid artery stenting com-pared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet. 2010;375:985–97.Google Scholar
  11. 11.
    Brott TG, Hobson RW 2nd, Howard G, et al.; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11–23.Google Scholar
  12. 12.
    Reiff T, Eckstein HH, Amiri H, et al.; SPACE-2 Study Group. Modification of SPACE-2 study design. Int J Stroke. 2014;9:E12–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Halliday A, Bulbulia R, Gray W, et al.; ACST-2 Collaborative Group. Status update and interim results from the asymptomat-ic carotid surgery trial-2 (ACST-2). Eur J Vasc Endovasc Surg. 2013;46:510–8.Google Scholar
  14. 14.
    Rosenfield K, Matsumura JS, Chaturvedi S, Riles T, Ansel GM, Metzger DC, Wechsler L, Jaff MR, Gray W, ACT I Investigators. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med. 2016;374:1011–20.CrossRefPubMedGoogle Scholar
  15. 15.
    Nedeltchev K, Pattynama PM, Biaminoo G, et al.; DEFINE Group. Standardized definitions and clinical endpoints in carotid artery and supra-aortic trunk revascularization trials. Catheter Cardiovasc Interv. 2010;76:333–44.Google Scholar
  16. 16.
    Krapf H, Nägele T, Kastrup A, et al. Risk factors for periprocedural complications in carotid artery stenting without filter protection: a serial diffusion-weighted MRI study. J Neurol. 2006;253:364–71.CrossRefPubMedGoogle Scholar
  17. 17.
    Aronow HD, Shishehbor M, Davis DA, et al. Leukocyte count predicts microembolic Doppler signals during carotid stenting: a link between inflammation and embolization. Stroke. 2005;36:1910–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Verhoeven BA, de Vries JP, Pasterkamp G, et al. Carotid atherosclerotic plaque characteristics are associated with micro-embolization during carotid endarterectomy and procedural outcome. Stroke. 2005;36:1735–40.CrossRefPubMedGoogle Scholar
  19. 19.
    Biasi GM, Froio A, Diethrich EB, et al. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the imaging in carotid angioplasty and risk of stroke (ICAROS) study. Circulation. 2004;110:756–62.CrossRefPubMedGoogle Scholar
  20. 20.
    de Campos Martins EC, Cremonesi A, Castriota F. Proposed practical anatomical-procedural classification systems for evaluating carotid lesions and carotid artery stenting. EuroIntervention. 2012;8:607–16.CrossRefPubMedGoogle Scholar
  21. 21.
    Cremonesi A, Roffi M, Carvalho de Campos Martins E, et al. Carotid Artery Stenting (chapter 42). In: Serruys PW, Wijns W, Vahanian A, editors. Percutaneous interventional cardiovascular medicine. The PCR-EAPCI textbook. Toulouse: PCR Publishing; 2012.Google Scholar
  22. 22.
    Angelini A, Reimers B, Della Barbera M, et al. Cerebral protection during carotid artery stenting: collection and histopatho-logic analysis of embolized debris. Stroke. 2002;33:456–61.CrossRefPubMedGoogle Scholar
  23. 23.
    Crawley F, Clifton A, Buckenham T, et al. Comparison of hemodynamic cerebral ischemia and microembolic signals detected during carotid endarterectomy and carotid angioplasty. Stroke. 1997;28:2460–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Al-Mubarak N, Roubin GS, Vitek JJ, et al. Effect of the distal-balloon protection system on microembolization during carotid stenting. Circulation. 2001;104:1999–2002.CrossRefPubMedGoogle Scholar
  25. 25.
    Kastrup A, Gröschel K, Krapf H, et al. Early outcome of carotid angioplasty and stenting with and without cerebral protec-tion devices: a systematic review of the literature. Stroke. 2003;34:813–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Reimers B, Schlüter M, Castriota F, et al. Routine use of cerebral protection during carotid artery stenting: results of a multicenter registry of 753 patients. Am J Med. 2004;116:217–22.CrossRefPubMedGoogle Scholar
  27. 27.
    Sprouse LR 2nd, Peeters P, Bosiers M. The capture of visible debris by distal cerebral protection filters during carotid artery stenting: is it predictable? J Vasc Surg. 2005;41:950–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Cremonesi A, Setacci C, Manetti R, et al. Carotid angioplasty and stenting: lesion related treatment strategies. EuroIntervention. 2005;1:289–95.PubMedGoogle Scholar
  29. 29.
    Zahn R, Mark B, Niedermaier N, et al. Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Embolic protection devices for carotid artery stenting: better results than stenting without protection? Eur Heart J. 2004;25:1550–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Castriota F, Cremonesi A, Manetti R, et al. Impact of cerebral protection devices on early outcome of carotid stenting. J Endovasc Ther. 2002;9:786–92.PubMedGoogle Scholar
  31. 31.
    Mas JL, Chatellier G, Beyssen B, EVA-3S Investigators. Carotid angioplasty and stenting with and without cerebral protec-tion: clinical alert from the Endarterectomy versus angioplasty in patients with symptomatic severe carotid Stenosis (EVA-3S) trial. Stroke. 2004;35:e18–20.PubMedGoogle Scholar
  32. 32.
    Wholey MH, Al-Mubarek N, Wholey MH. Updated review of the global carotid artery stent registry. Catheter Cardiovasc Interv. 2003;60:259–66.CrossRefPubMedGoogle Scholar
  33. 33.
    Whitlow PL, Lylyk P, Londero H, et al. Carotid artery stenting protected with an emboli containment system. Stroke. 2002;33:1308–14.CrossRefPubMedGoogle Scholar
  34. 34.
    Rabe K, Sugita J, Gödel H, et al. Flow-reversal device for cerebral protection during carotid artery stenting--acute and long-term results. J Interv Cardiol. 2006;19:55–62.CrossRefPubMedGoogle Scholar
  35. 35.
    Bersin RM, Stabile E, Ansel GM, et al. A meta-analysis of proximal occlusion device outcomes in carotid artery stenting. Catheter Cardiovasc Interv. 2012;80:1072–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Diederich KW, Scheinert D, Schmidt A, et al. First clinical experiences with an endovascular clamping system for neuro-protection during carotid stenting. Eur J Vasc Endovasc Surg. 2004;28:629–33.CrossRefPubMedGoogle Scholar
  37. 37.
    Coppi G, Moratto R, Silingardi R, et al. PRIAMUS – proximal flow blockage cerebral protectIon during carotid stenting: results from a multicenter Italian registry. J Cardiovasc Surg. 2005;46:219–27.Google Scholar
  38. 38.
    Pinter L, Ribo M, Loh C, et al. Safety and feasibility of a novel transcervical access neuroprotection system for carotid artery stenting in the PROOF study. J Vasc Surg. 2011;54:1317–23.CrossRefPubMedGoogle Scholar
  39. 39.
    Reimers B, Corvaja N, Moshiri S, et al. Cerebral protection with filter devices during carotid artery stenting. Circulation. 2001;104:12–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Nerla R, Castriota F, Micari A, Sbarzaglia P, Secco GG, Ruffino MA, de Donato G, Setacci C, Cremonesi A. Carotid artery stenting with a new-generation double-mesh stent in three high-volume Italian centres: clinical results of a multidisciplinary approach. EuroIntervention. 2016;12:e677–83.CrossRefPubMedGoogle Scholar
  41. 41.
    Bosiers M, Deloose K, Torsello G, Scheinert D, Maene L, Peeters P, Müller-Hülsbeck S, Sievert H, Langhoff R, Bosiers M, Setacci C. The CLEAR-ROAD study: evaluation of a new dual layer micromesh stent system for the carotid artery. EuroIntervention. 2016;12:e671–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Musialek P, Mazurek A, Trystula M, Borratynska A, Lesniak-Sobelga A, Urbanczyk M, Banys RP, Brzychczy A, Zajdel W, Partyka L, Zmudka K, Podolec P. Novel PARADIGM in carotid revascularisation: prospective evaluation of all-comer peRcutaneous cArotiD revascularisation in symptomatic and increased-risk asymptomatic carotid artery stenosis using CGuard™ MicroNet-covered embolic prevention stent system. EuroIntervention. 2016;12:e658–70.CrossRefPubMedGoogle Scholar
  43. 43.
    Schofer J, Musiałek P, Bijuklic K, et al. A prospective, multicenter study of a novel mesh-covered carotid stent: the CGuard CARENET trial (carotid embolic protection using MicroNet). JACC Cardiovasc Interv. 2015;8:1229–34.CrossRefPubMedGoogle Scholar
  44. 44.
    Bosiers M, de Donato G, Deloose K, et al. Does free cell area influence the outcome in carotid artery stenting? Eur J Vasc Endovasc Surg. 2007;33:135–41.CrossRefPubMedGoogle Scholar
  45. 45.
    Castriota F, de Campos Martins EC, Setacci C, et al. Cutting balloon angioplasty in percutaneous carotid interventions. J Endovasc Ther. 2008;15:655–62.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Roberto Nerla
    • 1
  • Kumara Ganesan
    • 1
  • Antonio Micari
    • 1
  • Fausto Castriota
    • 1
  • Alberto Cremonesi
    • 1
  1. 1.Interventional Cardiology Unit GVM Care & Research, Maria Cecilia HospitalCotignola (RA)Italy

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