Carotid artery stenting: When and how to do it?

Congress:

ECR 2019

Poster Number:

C-3408

Type:

Educational Exhibit

Keywords:

Ischaemia / Infarction, Embolism / Thrombosis, Arteriosclerosis, Stents, Recanalisation, Angioplasty, Ultrasound-Spectral Doppler, CT-Angiography, Catheter arteriography, Neuroradiology brain, Management, Interventional vascular

Authors:

R. N. M. Abdalla¹, E. T. E. Abdullah², A. Mugahid², A. H. A. H. Ibrahim², P. M. A. D. Mohamed Abouelhoda², M. M. M. Ashour³, M. A. M. Ayoub², S. Salah², A. D. Metry²; ¹Cairo, ca/EG, ²cairo/EG, ³Cairo, New Cairo/EG

DOI:

10.26044/ecr2019/C-3408

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-3408

Fig. 1: fig 1. Carotid Doppler showing carotid stenosis with high echogenicity and...

Fig. 2: fig 2. Sagittal CTA showing a calcific plaque causing severe carotid artery...

Fig. 3: fig 3. 3D TOF MRA showing severe carotid stenosis in left ICA origin.

Fig. 4: fig 4. A patient with severe symptomatic Carotid artery stenosis underwent CAS:...

Learning objectives

1. Review trials comparing carotid artery stenting and carotid endartrectomy and learn indications and contraindications of Carotid artery stenting. 2. Review the most recent updates and guidelines for carotid artery stenting and carotid endartrectomy in carotid artery stenosis. 3.overview the technique of carotid artery stenting and learn when to use cerebral protection device.

Background

The overall stroke prevalence is around 3%. Annually, 1.1 million stroke deaths occur in Europe making stroke the second most common cause of death. In the united states, one patient every 4 minutes die from a stroke. More than half of stroke survivors remain dependent in their daily activities on others. 20% of strokes are likely related to extracranial carotid artery disease. Individuals with asymptomatic carotid stenosis have an absolute stroke risk 3% per year, and more than 50% relative risk of stroke compared to...

Findings and procedure details

Several imgaing Modalities have been used to Diagnose Carotid artery stenosis including: Carotid duplex (fig 1) First line imaging modality for diagnosing carotid artery stenosis because of non-invasive, available, low cost with no contrast administration The degree of stenosis is determined using B-mode as well as different flow velocities. Table 1 shows how different velocities correlates with different degrees of stenosis. ICA stenosis (%) ICA PSV Cm/sec ICA EDV Cm/sec PSV ratio ICA/CCA Normal < 125 < 40 < 2.0 <50 % < 125 <...

Conclusion

Carotid artery stenting is a safe alternative procedure to Carotid endarterectomy in high risk patients for treatment of symptomatic carotid stenosis >60 %. Ongoing studies are currently conducted to assess the effectiveness of carotid interventions in asymptomatic patients. Carotid artery stenting can be used to protect against carotid blowouts, as an emergency salvage stent in patients with Acute ischemic stroke with ICA origin occlusion, and for treatment of carotid dissection and aneurysms.

Personal information

References

Heidenreich, P.A., et al., Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation, 2011. 123(8): p. 933-44. Morris, D.R., et al., Evidence-Based Carotid Interventions for Stroke Prevention: State-of-the-art Review. Journal of atherosclerosis and thrombosis, 2017. 24(4): p. 373-387. Noiphithak, R. and A. Liengudom, Recent Update on Carotid Endarterectomy versus Carotid Artery Stenting. Cerebrovasc Dis, 2017. 43(1-2): p. 68-75. Truelsen, T., et al., Stroke incidence and prevalence in Europe: a review of available data. Eur J...