Abstract
Stroke represents the third most common cause of death in the United States, and nearly 20% of strokes are caused by atherosclerotic carotid artery stenosis. During the past two decades, significant advances in medical therapy and prevention, surgical revascularization, and endovascular treatment options have revolutionized the approach to the management of patients with cerebrovascular disease. Through careful review of the clinical trials literature – both historical and contemporary – we explore areas of controversy and those where consensus exists, enabling the identification of “best practice,” tailored to suit the individual patient and clinical scenario.
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Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. 2010;121(7):e46–e215.
Lloyd-Jones D, Adams RJ, Carnethon M, et al. Heart Disease and Stroke Statistics—2009 Update; A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119: e21–e181.
Bates ER, Babb JD, Casey DE Jr, et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 clinical expert consensus document on carotid stenting: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting). J Am Coll Cardiol. 2007;49:126–170.
Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2006;113:e873–e923.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445–453.
Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995;273:1421–1428.
Debakey ME, Crawford ES, Cooley DA, Morris GC Jr, Garret HE, Fields WS. Cerebral arterial insufficiency: one to 11-year results following arterial reconstructive operation. Ann Surg. 1965;161:921–945.
Thacker EL, Wiggins KL, Rice KM, et al. Short-term and long-term risk of incident ischemic stroke after transient ischemic attack. Stroke. 2010;41(2):239–243.
Rothwell PM, Eliasziw M, Gutnikov SA, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003;361:107–116.
European Carotid Surgery Trialists’ Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351:1379–1387.
Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. 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;342:145–153.
Amarenco P, Bogousslavsky J, Callahan A 3 rd, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549–559.
Everett BM, Glynn RJ, MacFadyen JG, Ridker PM. Rosuvastatin in the prevention of stroke among men and women with elevated levels of C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER). Circulation;121:143–150.
Sacco RL, Adams R, Albers G, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006;37:577–617.
Biller J, Feinberg WM, Castaldo JE, et al. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1998;29:554–562.
Wennberg DE, Lucas FL, Birkmeyer JD, Bredenberg CE, Fisher ES. Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics. JAMA. 1998;279:1278–1281.
Rosenfield K. Carotid and Cerebrovascular Disease. In Cath SAP 3, ed. Moliterno DJ, section editor Mukherjee D. Washington DC: American College of Cardiology Foundation; 2008: 1012–1019.
Halliday A, Mansfield A, Marro J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004;363:1491–1502.
Kerber CW, Cromwell LD, Loehden OL. Catheter dilatation of proximal carotid stenosis during distal bifurcation endarterectomy. AJNR Am J Neuroradiol. 1980;1:348–349.
Garg N, Karagiorgos N, Pisimisis GT, et al. Cerebral protection devices reduce periprocedural strokes during carotid angioplasty and stenting: a systematic review of the current literature. J Endovasc Ther. 2009;16:412–427.
Chaturvedi S, Bruno A, Feasby T, et al. Carotid endarterectomy—an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005;65:794–801.
Roubin GS, New G, Iyer SS, et al. Immediate and late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis: a 5-year prospective analysis. Circulation. 2001;103:532–537.
Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet. 2001;357:1729–1737.
Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493–1501.
Gurm HS, Yadav JS, Fayad P, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008;358:1572–1579.
Gray WA, Hopkins LN, Yadav S, et al. Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg. 2006;44:258–268.
Mas JL, Chatellier G, Beyssen B, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660–1671.
Ringleb PA, Allenberg J, Bruckmann H, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006;368:1239–1247.
Eckstein HH, Ringleb P, Allenberg JR, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008;7:893–902.
Ederle J, Dobson J, Featherstone RL, et al. 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. 2010;375:985–997.
Bonati LH, Dobson J, Algra A, et al. Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data. Lancet. 2010;376:1062–1073.
Brott TG, Hobson RW 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11–23.
Landesberg G, Shatz V, Akopnik I, et al. Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol. 2003;42:1547–1554.
Kertai MD, Boersma E, Klein J, Van Urk H, Bax JJ, Poldermans D. Long-term prognostic value of asymptomatic cardiac troponin T elevations in patients after major vascular surgery. Eur J Vasc Endovasc Surg. 2004;28:59–66.
Safian RD, Bresnahan JF, Jaff MR, et al. Protected carotid stenting in high-risk patients with severe carotid artery stenosis. J Am Coll Cardiol. 2006;47:2384–2389.
Ansel GM, Hopkins LN, Jaff MR, et al. Safety and effectiveness of the INVATEC MO.MA proximal cerebral protection device during carotid artery stenting: results from the ARMOUR pivotal trial. Catheter Cardiovasc Interv. 2010;76:1–8.
Gray WA, Chaturvedi S, Verta P. Thirty-day outcomes for carotid artery stenting in 6320 patients from 2 prospective, multicenter, high-surgical-risk registries. Circ Cardiovasc Interv. 2009;2:159–166.
Grant A, White C, Ansel G, Bacharach M, Metzger C, Velez C. Safety and efficacy of carotid stenting in the very elderly. Catheter Cardiovasc Interv. 2010;75:651–655.
Uflacker R. Atlas of Vascular Anatomy: An Angiographic Approach. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2007.
Atkins MD, Bush RL. Embolic protection devices for carotid artery stenting: have they made a significant difference in outcomes? Semin Vasc Surg. 2007;20:244–251.
Caplan LR, Wityk RJ, Glass TA, et al. New England Medical Center Posterior Circulation Registry. Ann Neurol. 2004;56:389–398.
Savitz SI, Caplan LR. Vertebrobasilar disease. N Engl J Med. 2005;352:2618–2626.
Mukherjee D, Rosenfield K. Manual of Peripheral Vascular Interventions. Philadelphia: Lippincott, Williams & Wilkins; 2005.
Cloud GC, Markus HS. Diagnosis and management of vertebral artery stenosis. QJM. 2003;96:27–54.
Imparato AM. Vertebral arterial reconstruction: a nineteen-year experience. J Vasc Surg. 1985;2:626–634.
Thevenet A, Ruotolo C. Surgical repair of vertebral artery stenoses. J Cardiovasc Surg. 1984;25:101–110.
Sivenius J, Riekkinen PJ, Smets P, Laakso M, Lowenthal A. The European Stroke Prevention Study (ESPS): results by arterial distribution. Ann Neurol. 1991;29:596–600.
Jenkins JS, Patel SN, White CJ, et al. Endovascular stenting for vertebral artery stenosis. J Am Coll Cardiol;55:538–542.
Sundt TM Jr, Smith HC, Campbell JK, Vlietstra RE, Cucchiara RF, Stanson AW. Transluminal angioplasty for basilar artery stenosis. Mayo Clin Proc. 1980;55:673–680.
Mukherjee D, Roffi M, Kapadia SR, et al. Percutaneous intervention for symptomatic vertebral artery stenosis using coronary stents. J Invasive Cardiol. 2001;13:363–366.
Malek AM, Higashida RT, Phatouros CC, et al. Treatment of posterior circulation ischemia with extracranial percutaneous balloon angioplasty and stent placement. Stroke. 1999;30:2073–2085.
Jenkins JS, White CJ, Ramee SR, et al. Vertebral artery stenting. Catheter Cardiovasc Interv. 2001;54:1–5.
Chastain HD 2nd, Campbell MS, Iyer S, et al. Extracranial vertebral artery stent placement: in-hospital and follow-up results. J Neurosurg. 1999;91:547–552.
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Drachman, D.E., Ruggiero, N.J., Rosenfield, K. (2012). Carotid and Vertebral Intervention. In: Bhatt, D. (eds) Peripheral and Cerebrovascular Intervention. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-60327-965-9_6
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DOI: https://doi.org/10.1007/978-1-60327-965-9_6
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