Carotid Artery Stenosis Treatment Options
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Transcript of Carotid Artery Stenosis Treatment Options
Carotid Artery Stenosis
Treatment Options
Medical
Surgical: Carotid Endarterectomy
Endovascular: Carotid Stenting with CerebralProtection
Treatment Options
Stroke rate: 200 / 100.000 per annum 80% ischemic (20% hemorragic)
50% have a carotid artery stenosis
3rd leading cause of death
Clinical symptoms caused by embolic disease in > 80% of patients (< 20% by hemodynamicimpairment)
Carotid Artery Disease
Stroke Current Status in USA
1.5 deaths per 1000
Ranks 3 in cause of death
> 500,000 strokes per annum in USA
2 million survivors with need for ongoing care
Carotid artery occlusive disease accounts for 20-30 all strokes%
Carotid Artery Disease
Surgical Treatment: Endarterectomy
Carotid EndarterectomyPatch Grafting
Reduced risk of acute thrombosis
Increased incidence of use
Lesser use of vein patch
Carotid Angioplasty:
Kerber et al. 1980
Theron et al. 1987 48 pts, 4.1% serious morbidity
Gil-Peralta et al. 1996 82 pts, 0% mortality, 4.9% morbidity
Endovascular History
Drawbacks:
Vessel wall recoil
Angiographically evident dissection
Plaque dislodgement w/ embolisation
Higher restenosis rates
16%, versus 4% w/ stent (Theron, 1996)
Carotid Angioplasty
Carotid Artery Stenting Success Rate
Technical success > 95%
Proc. related mortality: 0.6 – 4.5%
Major stroke rates : 0 – 4.5%
Minor stroke rates : 0 – 6.5%
6-mo restenosis < 5%
Phatouros et al., Neurol.Med.Chir., 1999, 39:809-827
Angioplasty Technical SuccessN Tech
success
TIA Minor
Stroke
Major
Stroke
Death Restenosis >
50%
Roubin 238 96% 4% 2.3% 0.8% 0.5% 5% (6-mo)
Theron 259 94% 0% 2% 0% 0% 4% (1-yr)
Mathias 428 98% 2.3% 1.2% 0.3% 0.2% 9% (3-yr)
Bergeron 99 97% 4.1% 1% 0% 0% 3% (1yr)
Diethrich 238 91% 4.5% 2% 4.4% 1.5% 8% (2yr)
Gaines 251 96% 3.6% 4% 2.4%
Shawl,2000 170 99% 2.4% 0.5% 0.0% 2% (6-mo)
Peeters 90 96% 2.2% 2.2% 1.1% 2.2% 4% (1yr)
Placement of guiding catheter into CCA
Crossing the lesion
Dilatation of the stenosis
Stent implantation and dilatation
Embolisation May Occur During:
Cerebral Protection
Carotid Artery Stenting
Atherosclerotic lesions
Non-atherosclerotic lesions:
Fibromuscular Dysplasia (FMD)
Infectious disease
Dissection
Radiated neck
Recurrent stenosis after CEA
Restenosis after PTA+stent
Compression & Trauma
Lesion Types
Case 1 - Before dilation
After Stenting
Very calcifiedplaque
Case 2 - Before Dilation
Very calcified plaque
Case 2 – After Stenting & Post Dilation
Carotid Stent Angioplasty
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Thank you