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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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Periodicità: Bimestrale

ISSN 0021-9509

Online ISSN 1827-191X


The Journal of Cardiovascular Surgery 2006 Ottobre;47(5):519-46



Carotid angioplasty and stenting under protection. Techniques, results and limitations

Henry M. 1,2, Polydorou A. 3, Henry I. 4, Anagnostopoulou I. S. 5, Polydorou I. A. 3, Hugel M. 1,2

1 Clinic of Cardiology, Nancy, France
2 Global Research Institute Apollo Clinic, Hyderabad, India
3 Panteleimon General Hospital, Athens, Greece
4 Bois-Bernard Polyclinic, Bois-Bernard, France
5 Department of Anatomy University of Athens, Athens, Greece

A carotid stenosis is responsible for about 30% of strokes occurring. Carotid endarterectomy (CEA) is considered to be the gold standard treatment of a carotid stenosis. Carotid angioplasty and stenting (CAS) is emerging as a new alternative treatment for a carotid artery stenosis, but the risk of neurological complications and brain embolism remains the major drawback to this procedure. Therefore, in order to reduce the risks, we need: 1) * good indications, good patient and lesion selection; 2) correct techniques; 3) brain protection devices (cerebral protection devices should be routinely used and are mandatory for any procedure); 4) 3 types of protection devices are available, but filters are the most commonly used (all protection devices have limitations and cannot prevent from all embolic events; however, neurological complications can be reduced by 60%); 5) a good choice of the stent and correct implantation (all stents are not equivalent and have different geometrical effects); 6) pharmacological adjuncts; 7) a good team. Recent studies have shown that CAS has superior short-term outcomes than CEA in high surgical risk patients, but there are enough reported data to conclude that CAS is also not inferior to CEA in low-risk patients. CAS under protection is the standard of care and is maybe becoming the gold standard treatment of a carotid stenosis at least in some subgroups of patients.

lingua: Inglese


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