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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2013 February;54(1):1-10

language: English

History of carotid artery stenting

Roffi M. 1, Mathias K. 2

1 Division of Cardiology, University Hospital. Geneva, Switzerland;
2 Department of Radiology, , Teaching Hospital Dortmund, Dortmund Germany


The history of carotid artery stenting (CAS) was made by brave men and women who believed in a less invasive treatment modality than carotid endarterectomy (CEA) to treat carotid stenosis despite the risk – which was obviously present also with surgery – to cause a stroke, the very event that the procedure aimed to prevent. The bulky equipment, the lack of knowledge about the appropriate antithrombotic regimen, and the impossibility at early stage to influence distal embolization added to the pressure on the investigators. At times, the confrontation with the surgical community has been hard. The technique evolved with the inputs of multiple disciplines on both sides of the Atlantic including radiology, cardiology, neuroradiology and vascular surgery. Major breakthrough included the use of dual antiplatelet therapy, of self-expanding stents and of emboli protection devices. Unfortunately, randomized investigations against surgery started too early, in a phase in which the cas technique was not yet mature and the investigators lacked the necessary experience in terms of catheter skills and appropriate patient selection.

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