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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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

lingua: Inglese

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


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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.

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