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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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CAROTID ARTERY  UPDATE ON MANAGEMENT OF CAROTID, AORTIC AND PERIPHERAL ARTERIAL PATHOLOGIES


The Journal of Cardiovascular Surgery 2015 April;56(2):153-7

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Carotid artery stenting: high-risk interventionist versus high-risk center

Paraskevas K. I., Loftus I. M.

St. George’s Vascular Institute, St. George’s Healthcare NHS Trust, London, UK


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Carotid artery stenting (CAS) is a less invasive alternative to carotid endarterectomy (CEA) for the management of carotid artery stenosis. Although early multicenter randomized controlled trials reported inferior results for CAS compared with CEA, recent advances in technology and increasing CAS operator expertise have lead to improved results. As with any procedure, a high caseload translates into increased experience and better outcomes. This article discusses the current shortfalls of CAS, as well as the various options available to improve CAS results. The majority of studies suggest that there is an inverse relationship between caseload volume and CAS outcomes that defines high-risk interventionists and high-risk centers. Centralizing CAS procedures to high-volume centers is essential for optimization of CAS outcomes.

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Ian.Loftus@stgeorges.nhs.uk