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Carotid or Vertebral Angioplasty/Stenting
Jared Halpin, MD; Coleman O. Martin, MD; T. Gregory Walker, MD, FSIR
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • North American Symptomatic Carotid Endarterectomy Trial (NASCET): Randomized study; defined carotid revascularization indications
              • Severe carotid artery stenosis: ≥ 70% diameter stenosis
              • Preocclusive carotid stenosis: ≥ 90% diameter stenosis
            • Embolic protection device (EPD): Intravascular device designed to prevent dislodged plaque/debris/embolic material from occluding distal vasculature

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Procedure Steps

                    • Alternative Procedures/Therapies

                      POST PROCEDURE

                      • Things to Do

                        • Things to Avoid

                          OUTCOMES

                          • Problems

                            • Complications

                              • Expected Outcomes

                                Selected References

                                1. Rosenfield K et al: Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med. 374(11):1011-20, 2016
                                2. Ahn SH et al: Carotid artery stenting: review of technique and update of recent literature. Semin Intervent Radiol. 30(3):288-96, 2013
                                3. Brott TG et al: Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 363(1):11-23, 2010
                                4. Chaer RA et al: Cerebral reserve is decreased in elderly patients with carotid stenosis. J Vasc Surg. 52(3):569-74; discussion 574-5, 2010
                                5. Davis SM et al: Carotid-artery stenting in stroke prevention. N Engl J Med. 363(1):80-2, 2010
                                6. Paraskevas KI: Carotid artery stenting vs endarterectomy for carotid stenosis. Lancet. 376(9738):327, 2010
                                7. Gurm HS et al: Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 358(15):1572-9, 2008
                                8. Berenstein A et al: Surgical Neuroangiography, vol. 2. 2nd ed. Heidelberg, Berlin: Springer Verlag, 2004
                                9. Connors JJ, III et al: Interventional Neuroradiology: Strategies and Practical Techniques. Philadelphia: WB Saunders Company, 1999
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Preprocedure

                                    • Procedure

                                      • Outcomes

                                        TERMINOLOGY

                                        • Definitions

                                          • North American Symptomatic Carotid Endarterectomy Trial (NASCET): Randomized study; defined carotid revascularization indications
                                            • Severe carotid artery stenosis: ≥ 70% diameter stenosis
                                            • Preocclusive carotid stenosis: ≥ 90% diameter stenosis
                                          • Embolic protection device (EPD): Intravascular device designed to prevent dislodged plaque/debris/embolic material from occluding distal vasculature

                                        PREPROCEDURE

                                        • Indications

                                          • Contraindications

                                            • Preprocedure Imaging

                                              • Getting Started

                                                PROCEDURE

                                                • Procedure Steps

                                                  • Alternative Procedures/Therapies

                                                    POST PROCEDURE

                                                    • Things to Do

                                                      • Things to Avoid

                                                        OUTCOMES

                                                        • Problems

                                                          • Complications

                                                            • Expected Outcomes

                                                              Selected References

                                                              1. Rosenfield K et al: Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med. 374(11):1011-20, 2016
                                                              2. Ahn SH et al: Carotid artery stenting: review of technique and update of recent literature. Semin Intervent Radiol. 30(3):288-96, 2013
                                                              3. Brott TG et al: Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 363(1):11-23, 2010
                                                              4. Chaer RA et al: Cerebral reserve is decreased in elderly patients with carotid stenosis. J Vasc Surg. 52(3):569-74; discussion 574-5, 2010
                                                              5. Davis SM et al: Carotid-artery stenting in stroke prevention. N Engl J Med. 363(1):80-2, 2010
                                                              6. Paraskevas KI: Carotid artery stenting vs endarterectomy for carotid stenosis. Lancet. 376(9738):327, 2010
                                                              7. Gurm HS et al: Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 358(15):1572-9, 2008
                                                              8. Berenstein A et al: Surgical Neuroangiography, vol. 2. 2nd ed. Heidelberg, Berlin: Springer Verlag, 2004
                                                              9. Connors JJ, III et al: Interventional Neuroradiology: Strategies and Practical Techniques. Philadelphia: WB Saunders Company, 1999