Modern advances in endovascular and surgical interventions for patients with carotid artery disease


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Abstract

The article provides an overview of the latest achievements in the treatment of carotid artery disease. For a long time, carotid endarterectomy (CEA) was considered the best option in the treatment of patients with this pathology. However, with the advancement of technology and widespread use of endovascular therapies carotid angioplasty with stenting (CAS) comes to replace the CEA. The largest study comparing the results of CAS with the CEA, was the CREST trial (Carotid Revascularisation Endarterectomy Versus Stenting Trial), which did not show any significant differences in the primary composite endpoint (death, myocardial infarction and stroke in a period of 30 days after procedure) during 10 years of follow up (n=2502) between the stenting group (11.8%; 95% confidence interval - CI 9.1 to 14.8) and carotid endarterectomy group (9.9%; 95% CI, 7.9 to 12.2), (hazard ratio 1.10; 95% CI 0.83 to 1.44). However, there are still many unresolved issues. One of the most important is a high frequency of "small" strokes due to intraprocedural cerebral microembolization. It is hoped by solving these issues CAS will be considered the best option in the treatment of patients with carotid artery disease.

About the authors

F. B Shukurov

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

Email: fshukurov@gnicpm.ru
врач рентгенэндоваскулярных диагностики и лечения ФГБУ ГНИЦ ПМ 101000, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3

E. S Bulgakova

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

Email: ebulgakova@gnicpm.ru
аспирант отд-ния клин. кардиологии и молекулярной генетики ФГБУ ГНИЦ ПМ 101000, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3

B. A Rudenko

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

Email: brudenko@gnicpm.ru
д-р мед. наук, вед. науч. сотр. лаб. рентгенэндоваскулярных методов диагностики и лечения ФГБУ ГНИЦ ПМ 101000, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3

T. V Tvorogova

Hospital «Family»

Email: tvtvorogova@mail.ru
канд. мед. наук, глав. врач ООО «Клиника “Семья”» 141730, Russian Federation, Lobnya, ul. Tekstilnaya, d. 16

A. S Shanoyan

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

Email: ashanoyan@gnicpm.ru
канд. мед. наук, зав. отд-нием рентгенхирургических методов диагностики и лечения ФГБУ ГНИЦ ПМ 101000, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3

V. Yu Vlasov

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

Email: vvlasov@gnicpm.ru
мл. науч. сотр. лаб. рентгенэндоваскулярных методов диагностики и лечения ФГБУ ГНИЦ ПМ 101000, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3

D. A Feschenko

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

Email: dfeschenko@gnicpm.ru
врач рентгенэндоваскулярных диагностики и лечения ФГБУ ГНИЦ ПМ 101000, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3

References

  1. Медик В.А. Заболеваемость населения: история, современное состояние и методология изучения. М.: Медицина, 2013.
  2. Скворцова В.И., Чазова И.Е., Стаховская Л.В. Вторичная профилактика инсульта. М.: ПАГРИ, 2012.
  3. Feigin I. The general pathology of cerebrovascular disease. Amsterdam: Handbook of Clinical Neurology, 1972.
  4. De Bakey M. Successful carotid end arterectomy for cerebrovascular insufficiency: nineteen year follow - up. Lancet 1975; 233: 1083-5.
  5. Biller J, Feinberg W.M, Castaldo J.E et al. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Circulation 1998; 97: 501-9.
  6. White C.J. Carotid Artery Stenting. JACC 2014; 64: 722-31.
  7. White C.J, Ramee S.R. Carotid Artery Stenting: Patient, Lesion, and Procedural Characteristics that Increase Procedural Complications. Cathet Cardiovasc Intervent 2013: 1-12.
  8. European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet 1991; 337: 1235-43.
  9. 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: 445-53.
  10. Kerber C.W, Cromwell L.D, Loehden O.L. Catheter dilatation of proximal carotid stenosis during distal bifurcation endarterectomy. AJNR Am J Neuroradiol 1980; 1: 348-9.
  11. Ohki T, Parodi J, Veith F.J. Efficiacy of a proximal oclusion catheter with reversal of flow in the prevention of embolic events during carotid artery stenting. J Vasc Surg 2001; 33: 504-9.
  12. Bockenheimer S.A, Mathias K. Percutaneous transluminal angioplasty in atherosclerotic internal carotid artery stenosis. AJNR Am J Neuroradiol 1983; 4: 793-5.
  13. CAVATAS Investigators. 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: 1729-37.
  14. Dietrich E.B, Ndiaye M, Reid D.B et al. Stenting in the Carotid Atrery: Initial Experience in 110 Patients. J Endovasc Surg 1996; 3: 42-62.
  15. Yadav J. Protected CAS versus Endarterectomy in High-Risk Patients. N Engl J Med 2004; 351: 1493-1501.
  16. Brott T.G, Hobson R.W 2nd, Howard G et al. Stenting vsendarterectomy for treatment of carotid - artery stenosis. N Engl J Med 2010; 363: 11-23.
  17. Grant A, White C, Ansel G et al. Safety and efficacy of carotid stenting in the very elderly. Cathet Cardiovasc Intervent 2010; 75: 651-5.
  18. Brott T.G, Howard G, Roubin G.S et al. Long - Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis. N Engl J Med 2016; 374: 1021-31.
  19. Setacci C, de Donato G, Chisci E et al. Is carotid artery stenting in octogenarians really dangerous? J Endovasc Ther 2006; 13: 302-9.
  20. Roubin G.S, New G, Iyer S.S 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: 532-7.
  21. Macdonald S, Lee R, Williams R et al. Gon behalf of the Delphi Carotid Stenting Consensus Panel. Towards safer carotid artery stenting: A scoring system for anatomic suitability. Stroke 2009; 40: 1698-1703.
  22. Setacci C, Chisci E, Setacci F et al. Siena carotid artery stenting score: A risk modelling study for individual patients. Stroke 2010; 41: 1259-65.
  23. Gray W.A, Rosenfield K.A, Jaff M.R et al. Influence of site and operator characteristics on carotid artery stent outcomes: Analysis of the CAPTURE 2 (Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events) clinical study. JACC Cardiovasc Interv 2011; 4: 235-46.
  24. Mathur A, Roubin G.S, Iyer S.S et al. Predictors of stroke complicating carotid artery stenting. Circulation 1998; 97: 1239-45.
  25. Krapf H, Nagele 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.
  26. Biasi G.M, 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: 756-2.
  27. Tanemura H, Maeda M, Ichikawa N et al. High - risk plaque for carotid artery stenting evaluated with 3-dimensional t1-weighted gradient echo sequence. Stroke 2013; 44: 105-10.
  28. Dangas G.I, Laird J.R, Satler L.F et al. Postprocedural hypotension after carotid artery stent placement: predictors and short - and long - term clinical outcomes. Radiology 2000; 215 (3): 677-83.
  29. Lavoiea P, Rutledgeb J, Dawouda M.A et al. Predictors and Timing of Hypotension and Bradycardia after Carotid Artery Stenting. Am J Neuroradiology 2008, 29: 1942-7.

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