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8 - Interventional management of carotid disease

from Background

Published online by Cambridge University Press:  03 December 2009

By
Andrew G. Clifton
Edited by
Jonathan Gillard ,
Martin Graves ,
Thomas Hatsukami  and
Chun Yuan
Andrew G. Clifton
Affiliation:
St George's Hospital, London SW17 0QT, UK
Jonathan Gillard
Affiliation:
University of Cambridge
Martin Graves
Affiliation:
University of Cambridge
Thomas Hatsukami
Affiliation:
University of Washington
Chun Yuan
Affiliation:
University of Washington
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Summary

Surgical trials and the role of surgery

Stroke is the third most common cause of death in the Western world, and atherosclerotic stenosis of the carotid artery, close to the carotid bifurcation in the neck, causes about 10% of all strokes and transient ischemic attacks (TIA) (Clifton, 2002). For patients who have had recent symptoms associated with severe carotid stenosis the additional risk of stroke over the next 2 years is thought to be 20% or more if patients are treated medically and is thought to be greater in patients with very severe stenosis (Dennis et al., 1990). It may be as high as 28% (North American Symptomatic Carotid Endarterectomy Trial Collaborators, 1991). Recent studies have shown, however, that the risks may be greater. The Oxford Community Stroke Project showed that much data looks at risk of stroke from either the date seen by a neurologist or from the date referred to at TIA service. They showed that the risk of stroke from the date of the first ever TIA was much greater in the first 30 days, in the region of 12%+ (Coull et al., 2004). It has also been shown that the odds of having a stroke when the patient is found to have large artery disease, i.e. significant carotid stenosis, is much greater than if the cause is found to be secondary to small vessel disease or cardiac embolism (Lovett et al., 2003).

Keywords

asymptomatic carotid surgeryatherosclerosiscarotid angioplastycarotid stenosistransatlantic asymptomatic carotid interventional trialstrokecarotid stenting
Type
Chapter
Information
Carotid Disease
The Role of Imaging in Diagnosis and Management
 , pp. 94 - 104
Publisher: Cambridge University Press
Print publication year: 2006

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References

Alberts, M. J. (2001). Results of a multi-centre prospective randomised trial of carotid artery stenting versus carotid endarterectomy. Stroke, 32, 325 abstract.Google Scholar
Beebe, H. G. (1998). Scientific evidence demonstrating safety of carotid angioplasty and stenting: do we have enough to draw conclusions yet?Journal of Vascular Surgery, 27, 788–90.CrossRefGoogle ScholarPubMed
Beebe, H. G., Archie, J. P., Baker, W. H., et al. (1996). Concern about the safety of carotid angioplasty. Stroke, 27, 788–90.CrossRefGoogle ScholarPubMed
Brooks, W. H., Kleer, R. R., Jones, M. R., Coleman, T. L. and Ethet, L. (2001). Carotid angioplasty and stenting versus carotid endarterectomy, randomised trial in a community hospital. Journal of the American College of Cardiology, 38, 1589–95.CrossRefGoogle Scholar
Brown, M. M. (1996a). Balloon angioplasty for extracranial carotid disease. In Advances in Vascular Surgery, Vol. 4, ed. Saunders, W.B. St Louis MO: Mosby Year Book, pp. 53–69.Google Scholar
Brown, M. M., Clifton, A. and Taylor, R. S. (1996b). Concern about the safety of carotid angioplasty. Stroke, 27, 1435.Google Scholar
Brown, M. M., Vernables, G., Clifton, A., et al. (1997). Carotid endarterectomy versus carotid angioplasty. Lancet, 349, 880–1.CrossRefGoogle Scholar
Carotid and vertebral artery transluminal angioplasty study Investigators (2001). Endovascular versus surgical treatment in patients with carotid stenosis and the Carotid and Vertebral Artery Transluminal Angioplasty Study (Carotid and vertebral artery transluminal angioplasty study): a randomised trial. Lancet, 357, 1729–37.CrossRef
Clifton, A. (2002). Prevention of ischaemic stroke, the role of angioplasty and stenting in treatment of carotid and vertebral artery atherosclerotic disease. In Interventional Neuroradiology, ed. Byrne, J.. Oxford: Oxford University Press, pp. 291–308.Google Scholar
Connors, J. J., Sacks, D., Furlan, A. J., et al. (2004). Training, competency and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting and cerebrovascular intervention. American Journal of Neuroradiology, 25, 1732–41.Google ScholarPubMed
Coull, A. J., Lovett, J. K. and Rothwell, P. M. (2004). Transient ischaemic attacks and minor strokes put patients at high risk for repeat stroke. Journal of Clinical Outcomes Management, 11, 139.Google Scholar
Coward, L. J., Featherstone, R. L. and Brown, M. M. (2005). Safety and efficacy of endovascular treatment of carotid artery stenosis compared with carotid endarterectomy. A Cochrane systematic review of the randomised evidence. Stroke, 36, 905–11.CrossRefGoogle Scholar
Crawley, F., Brown, M. M. and Clifton, A. (1998). Angioplasty and stenting in the carotid and vertebral arteries. Postgraduate Medical Journal, 74, 7–10.CrossRefGoogle ScholarPubMed
Cremonesi, A., Manette, R. and Setalli, F. (2003). Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients. Stroke, 34, 1936–43.CrossRefGoogle ScholarPubMed
Dennis, M., Banford, J., Sandercock, P. and Warlow, C. (1990). Prognosis of transient ischaemic attacks in the Oxfordshire stroke project. Stroke, 21, 848–51.CrossRefGoogle ScholarPubMed
European Carotid Surgery Trialists Collaboration Group, Medical research council European Carotid Surgery Trial. (1991). Interim result for symptomatic patients with severe (70–79%) or with mild (0–29%) carotid stenosis. Lancet, 337, 1235–43.CrossRef
EVA-Endarterectomy versus angioplasty in patients with severe symptomatic carotid stenosis. (2004). Clinical alert from the endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis (EVA-Endarterectomy versus angioplasty in patients with severe symptomatic carotid stenosis) trial. Stroke, 35, E18–E21.
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995). Endarterectomy for asymptomatic carotid stenosis. Journal of the American Medical Association, 273, 1421–8.CrossRef
Halliday, A., Mansfield, A., Marrow, J., et al. (2004). Medical research councilA Asymptomatic carotid surgery trial (Asymptomatic carotid surgery trial) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms, randomised controlled trial. Lancet, 363, 1491–502.Google Scholar
Hurst, R. E. (1996). Editorial. Carotid angioplasty. Radiology, 201, 613–16.CrossRefGoogle ScholarPubMed
Kastrup, A., Groschel, K., Krap, H., et al. (2003). Early outcome of carotid stenting with and without cerebral protection devices: a systemic review of the literature. Stroke, 34, 813–19.CrossRefGoogle Scholar
Lambert, M. (1995). Editorial. Should carotid endarterectomy be purchased? Purchasers need a broader perspective. British Medical Journal, 310, 317–18.CrossRefGoogle Scholar
Lovett, J. K., Coull, A. and Rothwell, P. M. (2003). Early risk of recurrent stroke by aetiological subtype; complications for stroke prevention. Journal of Neurosurgery, Neurology and Psychiatry, 74, 1448.Google Scholar
Naylor, A. R., Bolier, A., Abbott, R. J., et al. (1998). Randomised study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. Journal of Vascular Surgery, 28, 326–34.CrossRefGoogle Scholar
Naylor, A. R., London, N. J. M. and Bell, P. R. F. (1997). Carotid endarterectomy versus carotid angioplasty. Lancet, 349, 203–4.CrossRefGoogle ScholarPubMed
North American Symptomatic Carotid Endarterectomy Trial Collaborators. (1991). Beneficial effects of carotid endarterectomy in symptomatic patients with high grade carotid stenosis. New England Journal of Medicine, 325, 445–53.CrossRef
Rothwell, P. (1995). Morbidity and mortality of carotid endarterectomy in the European Carotid Surgery Trial (abstract). Cerebrovascular Diseases, 4, 226.Google Scholar
Rothwell, P., Eliasziw, M., Gutnusv, S. A., Warlow, C. P., et al. (2004). Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet, 363, 915–24.CrossRefGoogle ScholarPubMed
Rothwell, P., Slattery, J. and Warlow, C. (1996a). A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. Stroke, 27, 260–5.CrossRefGoogle Scholar
Rothwell, P., Slattery, J. and Warlow, C. (1996b). A systematic comparison of the risks of stroke and death due to endarterectomy for symptomatic and asymptomatic carotid stenosis. Stroke, 27, 266–9.CrossRefGoogle Scholar
Sacks, D. and Connors, J. J., , III. (2005). Carotid stent placement, stroke prevention, and training. Radiology, 234, 49–52.CrossRefGoogle ScholarPubMed
Sundt, T. M., Sandok, B. and Whisnant, J. P. (1975). Carotid endarterectomy: complications and preoperative assessment of risk. Mayo Clinic Proceedings, 50, 301–6.Google Scholar
Vos, A. J., Berg, J. C., Ernst, S. M. P. G., et al. (2005). Carotid angioplasty and stent placement: comparison of transcranial Doppler ultrasound data and clinical outcome with and without filtering in 509 patients. Radiology, 234, 493–9.CrossRefGoogle ScholarPubMed
Wholey, M. H., Mathias, H., Rubin, G. S., et al. (2000). Global experience in cervical carotid artery stent placement. Catheterization and Cardiovascular Interventions, 50, 160.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
Yadav, Y. S., Wholey, M. J. and Kunts, R. E. (2004). Protected carotid artery stenting versus endarterectomy in high risks patients. New England Journal of Medicine, 351, 1493–501.CrossRefGoogle Scholar

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