Carotid and Vertebral Artery Intervention

  • Stephen D. Goode
  • Trevor J. Cleveland
Part of the Medical Radiology book series (MEDRAD)


Stroke is the third most common cause of death worldwide. Current treatments for significant carotid artery stenotic disease include carotid endarterectomy and carotid artery stenting. We present a synopsis of the current evidence available comparing these two treatments in addition to indications, technical aspects and post-procedural care for patients undergoing carotid artery stenting. Similarly we present the indications, technical aspects and post-procedural details for vertebral artery intervention.


Carotid Artery Stenting Protection Device Carotid Artery Disease North American Symptomatic Carotid Endarterectomy Trial Ipsilateral Stroke 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adami CA, Scuro A, Spinamano L et al (2002) Use of the Parodi anti-embolism system in carotid stenting: Italian trial results. J Endovasc Ther 9:147–154PubMedCrossRefGoogle Scholar
  2. Akins PT, Kerber CW, Pakbaz RS (2008) Stenting of vertebral artery origin atherosclerosis in high-risk patients: bare or coated? A single-center consecutive case series. J Invasive Cardiol 20:14–20PubMedGoogle Scholar
  3. Albuquerque FC, Fiorella D, Han P et al (2003) A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. Neurosurgery 53:607–614 discussion 614-6PubMedCrossRefGoogle Scholar
  4. Ansel GM, Hopkins LM, Jaff MR et al (2010) Safety and effectiveness of the INVATEC MO.MA (R) proximal cerebral protection device during carotid artery stenting: results from the ARMOUR pivotal trial. Catheter Cardiovasc Interv 76:1–8PubMedCrossRefGoogle Scholar
  5. Barbato JE, Dillavou E, Horowitz MB et al (2008) A randomized trial of carotid artery stenting with and without cerebral protection. J Vasc Surg 47:760–765PubMedCrossRefGoogle Scholar
  6. Barnett HJM, Taylor DW, Eliasziw M et al (1998) Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. NEJM 339:1415–1425PubMedCrossRefGoogle Scholar
  7. Bockenheimer SA, Mathias K (1983) Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis. AJNR 4:791–792PubMedGoogle Scholar
  8. Bonati LH, Ederle J, McCabe DJH et al (2009) New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 9:353–362CrossRefGoogle Scholar
  9. Brooks WH, McClure RR, Jones MR et al (2001) Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol 38:1589–1595PubMedCrossRefGoogle Scholar
  10. Brooks WH, McClure RR, Jones MR et al (2004) Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: a randomized trial in a community hospital. Neurosurgery 54:318–324 discussion 324-5PubMedCrossRefGoogle Scholar
  11. Brott TG, Hobson RW, Howard G et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23PubMedCrossRefGoogle Scholar
  12. Brown MM, Rogers J, Bland JM (2001) Endovascular versus surgical treatment in patients with carotid stenosis in the carotid and vertebral artery transluminal angioplasty study (CAVATAS): a randomised trial. Lancet 357:1729–1737CrossRefGoogle Scholar
  13. Caplan LR, Wityk RJ, Glass TA et al (2004) New England Medical Center posterior circulation registry. Ann Neurol 56:389–398PubMedCrossRefGoogle Scholar
  14. Carotid Stenting Triallists Collaboration (2010) Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data. Lancet 376:1062–1073CrossRefGoogle Scholar
  15. Chimowitz MI, Kokkinos J, Strong J et al (1995) The warfarin-aspirin symptomatic intracranial disease study. Neurology 45:1488–1493PubMedCrossRefGoogle Scholar
  16. Coutheoux P, Theron J, Tournade A et al (1987) Percutaneous endoluminal angioplasty of post endarterectomy carotid stenoses. Neuroradiology 29:186–189CrossRefGoogle Scholar
  17. Coward LJ, Featherstone RL, Brown MM (2005) Percutaneous transluminal angioplasty and stenting for vertebral artery stenosis. Cochrane Database Syst Rev CD000516Google Scholar
  18. Criado E, Fontcuberta J, Orgaz A et al (2007) Transcervical carotid stenting with carotid artery flow reversal: 3-year follow-up of 103 stents. J Vasc Surg 46:864–869PubMedCrossRefGoogle Scholar
  19. Dabus G, Gerstle RJ, Derdeyn CP et al (2006) Endovascular treatment of the vertebral artery origin in patients with symptoms of vertebrobasilar ischemia. Neuroradiology 48:917–923PubMedCrossRefGoogle Scholar
  20. Deriu GP, Ballotta E, Francheschi L et al (1991) Surgical management of extracranial vertebral artery occlusive disease. J Cardiovasc Surg (Torino) 32:413–419Google Scholar
  21. Edgell RC, Yavagal DR, Drazin D et al (2010) Treatment of vertebral artery origin stenosis with anti-proliferative drug-eluting stents. J Neuroimaging 20:175–179PubMedCrossRefGoogle Scholar
  22. Ederle J et al (2010) Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 375(9719):985–997PubMedCrossRefGoogle Scholar
  23. European Carotid Surgery Triallist’s Collaborative Group (1998) Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST) Lancet 351:1379–1387Google Scholar
  24. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995) Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273:1421–1428CrossRefGoogle Scholar
  25. Flossmann E, Rothwell PM (2003) Prognosis of vertebrobasilar transient ischaemic attack and minor stroke. Brain 126:1940–1954PubMedCrossRefGoogle Scholar
  26. Halliday A et al (2004) Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 363(9420):1491–1502PubMedCrossRefGoogle Scholar
  27. Halliday AW, ThomasD Mansfield A (1994) The asymptomatic carotid surgery trial (ACST). Rationale and design. Eur J Vasc Surg 8:703–710PubMedCrossRefGoogle Scholar
  28. Halliday AW, Thomas DJ, Mansfield AO (1995) The asymptomatic carotid surgery trial (ACST). Int Angiol 14:18–20PubMedGoogle Scholar
  29. Halliday A, Harrison M, Hayter E et al (2010) 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet 376:1074–1084PubMedCrossRefGoogle Scholar
  30. Hatano T, Tsukahara T, Ogino E et al (2005) Stenting for vertebrobasilar artery stenosis. Acta Neurochir Suppl 94:137–141PubMedCrossRefGoogle Scholar
  31. Imparato AM (1985) Vertebral arterial reconstruction: a nineteen-year experience. J Vasc Surg 2:626–634PubMedGoogle Scholar
  32. Lin YH, Liu YC, Tseng WY et al (2006) The impact of lesion length on angiographic restenosis after vertebral artery origin stenting. Eur J Vasc Endovasc Surg 32:379–385PubMedCrossRefGoogle Scholar
  33. Macdonald S, Evans DH, Griffiths PD et al (2010) Filter-protected versus unprotected carotid artery Stenting: A Randomised Trial. Cerebrovasc Dis 29:282–289PubMedCrossRefGoogle Scholar
  34. Mas J, Chatellier G, Beyssen B et al (2006) Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. New Engl J Med 355:1660–1671PubMedCrossRefGoogle Scholar
  35. Naylor AR, Bolia A, Abbott RJ et al (1998) Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. J Vasc Surg 28(2):326–334PubMedCrossRefGoogle Scholar
  36. NICE, IPG389 Carotid artery stent placement for symptomatic extracranial carotid stenosis. 2011Google Scholar
  37. Park MS, Fiorella D, Stiefel MF et al (2010) Vertebral artery origin stents revisited: improved results with paclitaxel-eluting stents. Neurosurgery 67:41–48PubMedCrossRefGoogle Scholar
  38. Parodi JC, La Mura R, Ferriera LM et al (2000) Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices. J Vasc Surg 32:1127–1136PubMedCrossRefGoogle Scholar
  39. Parodi JC (2005) Is flow reversal the best method of protection during carotid stenting? J Endovasc Ther 12:166–168 discussion 168–170PubMedCrossRefGoogle Scholar
  40. Rapp JH, Zhu L, Hollenbeck K et al (2009) Distal filtration versus flow reversal: an ex vivo assessment of the choices for carotid embolic protection. J Vasc Surg 49:1181–1188PubMedCrossRefGoogle Scholar
  41. Ringleb PA et al (2006) 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 368(9543):1239–1247PubMedCrossRefGoogle Scholar
  42. Rothwell PM, Eliasziw M, Gutnikov SA et al (2003) Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 361:107–116PubMedCrossRefGoogle Scholar
  43. Rothwell PM, Goldstein LB (2004) Carotid endarterectomy for asymptomatic carotid stenosis: asymptomatic carotid surgery trial. Stroke 35:2425–2427PubMedCrossRefGoogle Scholar
  44. Rudarakanchana N, Dialynas M, Halliday A (2009) Asymptomatic carotid surgery trial-2 (ACST-2): rationale for a randomised clinical trial comparing carotid endarterectomy with carotid artery stenting in patients with asymptomatic carotid artery stenosis. Eur J Vasc Endovasc Surg 38:239–242PubMedCrossRefGoogle Scholar
  45. Savitz SI, Caplan LR (2005) Vertebrobasilar disease. N Engl J Med 352:2618–2626PubMedCrossRefGoogle Scholar
  46. Sleight SP, Poloniecki J, Halliday AW (2002) Asymptomatic carotid stenosis in patients on medical treatment alone. Eur J Vasc Endovasc Surg 23:519–523PubMedCrossRefGoogle Scholar
  47. Wityk RJ, Chang HM, Rosengart A et al (1998) Proximal extracranial vertebral artery disease in the New England Medical Center posterior circulation registry. Arch Neurol 55:470–478PubMedCrossRefGoogle Scholar
  48. Yadav JS, Wholey MH, Kuntz RE et al (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Sheffield Vascular Institute, Northern General HospitalSheffieldUK

Personalised recommendations