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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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  CAROTID CONSENSUS UPDATE


Italian Journal of Vascular and Endovascular Surgery 2011 June;18(2):151-9

language: English

Carotid artery revascularization in high-risk patients

Natarajan S. K. 1,2,4, Snyder K. V. 1,3,4, Levy E. I. 1,4,. Siddiqui A. H. 1,4, Hopkins L. N. 1,4

1 Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo State University of New York Buffalo, NY, USA
2 Department of Neurosurgery, Millard Fillmore Gates Circle Hospital, Kaleida Health, Buffalo, NY, USA
3 Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo State University of New York, Buffalo, NY, USA
4 Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo State University of New York, Buffalo, NY, USA


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Carotid endarterectomy (CEA) became an accepted method for carotid revascularization on the basis of early trials, especially North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Asymptomatic Carotid Atherosclerosis Study (ACAS). Simultaneously, CAS was being proposed as a minimally invasive alternative to CEA, and the proponents of CAS started evaluating carotid artery stenting (CAS) in patients who would have been excluded from participation in the CEA trials. Patients who were excluded from the CEA trials by the investigators were deemed to be at high-risk for CEA based on many years of experience. These beliefs were reinforced by the results of the SAPPHIRE trial and the CAS reimbursement guidelines from the FDA and the CMS. The Food and Drug Administration (FDA) objective performance criteria for CEA were based on an exhaustive literature review, as well as experience factors noted above. Current studies are helping to better define high risk for patients with precise estimates of stroke risks and other CEA-associated risks. As experience with CAS is increasing, there is mounting evidence to identify patients with high-risk for CAS.

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