REVIEW  RECENT ADVANCES IN THE TREATMENT OF CAROTID ARTERY DISEASE 

The Journal of Cardiovascular Surgery 2019 June;60(3):345-53

DOI: 10.23736/S0021-9509.19.10922-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Recent advances in the treatment of carotid artery disease

Patric LIANG, Winona W. WU, Marc L. SCHERMERHORN ✉

Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

Transfemoral carotid stenting has struggled to become a suitable alternative to carotid endarterectomy for the treatment of carotid disease because of higher perioperative stroke risks, even with use of embolic protection devices. To reduce the perioperative stroke rates associated with carotid stenting, several advancements in stent design, embolic protection systems, and technical approaches have been developed. Transcarotid artery revascularization (TCAR) was also recently introduced as a novel carotid artery stenting option which circumvents several of the high embolic-risk maneuvers found in transfemoral carotid stenting and employs a flow reversal system that provides continuous embolic protection throughout the procedure. Early results from this technique have shown low stroke/death rates comparable to carotid endarterectomy while maintaining the minimally invasive benefits of carotid stenting. TCAR has a strong potential to become the preferred method of carotid stenting in the near future and may challenge carotid endarterectomy as the preferred carotid artery revascularization method.

KEY WORDS: Carotid arteries; Carotid artery diseases; Stents