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THE JOURNAL OF CARDIOVASCULAR SURGERY
A Journal on Cardiac, Vascular and Thoracic Surgery
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
REVIEWS NEW TOOLS IN ENDOVASCULAR SURGERY
The Journal of Cardiovascular Surgery 2016 December;57(6):769-83
Carotid artery stenting renaissance: is it safe and effective using new materials?
Gianmarco DE DONATO 1, Giulia MAZZITELLI 1, Umberto RUZZI 1, Mariagnese MELE 1, Marco TADIELLO 1, Giovanni GIANNACE 1, Francesco SETACCI 2, Giuseppe GALZERANO 1, Carlo SETACCI 1 ✉
1 Vascular Surgery, University of Siena, Siena, Italy; 2 Vascular Surgery, Casa di Cura Giovanni XXIII, Monastier di Treviso, Treviso, Italy
Data from randomized controlled trials (RCTs) demonstrated significant differences between carotid artery stenting (CAS) and carotid endarterectomy (CEA) in terms of early neurological outcomes (from 0 to 30 days), although mid- and long-term neurological results are indistinguishable. CAS in symptomatic standard risk patients is coupled with a higher risk of any stroke, and death or any stroke at 30 days, while the rates of disabling or major stroke do not vary remarkably between treatments. Since the micro-embolization through the stent struts is the primary suspected cause of suspected early postoperative neurological complications (i.e., non-disabling stroke), surgical technology has focused on the production of a new generation of stents with a double layer of mesh to reduce the “free area” of the cells, and on new cerebral protection devices. Another major determinant of early negative outcomes is believed to be the intraluminal manipulation occurring during carotid engagement from the aortic arch, the crossing maneuvers at the level of the culprit lesion and vessel trauma during angioplasty. To address these subject matters, new embolic protection devices and innovative strategies have been developed, consequently. This review is designed to furnish the current status of CAS results, to update the ongoing RCTs comparing CAS vs. CEA outcomes, and to recapitulate the features and clinical outcomes for a new carotid stent design, the so called “mesh-stents”, and new embolic protection tools.