This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Verzini, F. Articles by Cao, P. Search for Related Content PubMed PubMed Citation Articles by Verzini, F. Articles by Cao, P. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Stroke Social Bookmarking                   What's this?

Carotid Artery Stenting: Technical Issues and Role of Operators' Experience

Division of Vascular and Endovascular Surgery, University of Perugia, Perugia, Italy

Paola De Rango, MD

Division of Vascular and Endovascular Surgery, University of Perugia, Perugia, Italy

Gianbattista Parlani, MD

Division of Vascular and Endovascular Surgery, University of Perugia, Perugia, Italy

Giuseppe Panuccio, MD

Division of Vascular and Endovascular Surgery, University of Perugia, Perugia, Italy

Piergiorgio Cao, MD, FRCS

Division of Vascular and Endovascular Surgery, University of Perugia, Perugia, Italy, pcao{at}unipg.it

Major criticism of randomized clinical trials comparing carotid artery stenting (CAS) and carotid endarterectomy (CEA) focused on the incomplete learning curve of interventionists and the inadequate and outdated technology employed, which might have contributed to the high stroke and death rates in the CAS arm. The effect of the learning curve related to technical expertise and patient selection strongly influences the results of CAS. Due to the devastating potential complications when compared with other endovascular minimally invasive procedures, CAS requires a more strict analysis of operator training and outcome, because improvement in the learning curve is accompanied by a comparative reduction in complication rates. Today, there is a general agreement that requirements for training in CAS are higher than in other fields. In contrast to many endovascular peripheral arterial interventions, CAS represents a more challenging procedure because it involves complex catheter-based skills. Training experience attempts to sensibly reduce strokes that may occur during the unprotected phases of catheterization/approach to the target vessel and the protected phase of ballooning/stenting and cerebral protection device retrieval. Mandatory training, familiarity with the indications and contraindications, and knowledge of the technology and devices are paramount for the success of CAS, and preprocedure, intraprocedure, and postprocedure patient management is essential for reducing morbidity and mortality. These prerequisites are essential to allow CAS to be accepted as a potential alternative to CEA.

Key Words: carotid artery stenting • carotid endarterectomy • randomized clinical trails

Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 20, No. 3, 247-257 (2008)
DOI: 10.1177/1531003508323733


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?