Carotid stenting and other interventions

Endovascular treatment was first used in the Umbs in the 1960s and subsequently in the renal and coronary arteries (Dotter et al. 1967), but it was introduced more cautiously for treatment of stenosis of the cerebral, carotid and vertebral arteries because of the perception of a likely high procedural risk of stroke. 

Data on the complication rates of carotid angioplasty/stenting are available from published case series and registries but, as was demonstrated for endarterectomy (see Chs. 25 and 27), such studies tend to underestimate risks. Formal randomized comparisons of endarterectomy and angioplasty/stenting are, therefore, required for reliable determination of the overall balance of risks and benefits. Prior to 2006, only five relatively small randomized controlled trials (1269 patients) had been reported (Naylor et al. 1998 Alberts 2001 Brooks et al. 2001 CAVATAS Investigators 2001 Yadav et al. 2004). The largest of 

Procedure carried out under local anesthetic with consequent better neurological monitoring and reduced anesthetic complications 

Reduced procedural blood pressure variability Reduced local wound complications 

Reduced local nerve damage Reduced length of stay in hospital 

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Vein graft and carotid interventions, possible use in other peripheral interventions (e.g., renal arteries) Obtain more anatomical information, evaluate lesion morphology or adequacy of intervention (e.g., stent expansion)... 

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