Carotid artery stenting: current and emerging options

Simon Morr,1,4 Ning Lin,1,4 Adnan H Siddiqui1–5 1Department of Neurosurgery, 2Department of Radiology, School of Medicine and Biomedical Sciences, 3Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, 4Department of Neurosurgery, Gates Vascular...

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Autores principales:	Morr S, Lin N, Siddiqui AH
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Medical technology R855-855.5
Acceso en línea:	https://doaj.org/article/a5b7afd07f1e485297191c1e55ce6f96
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spelling	oai:doaj.org-article:a5b7afd07f1e485297191c1e55ce6f962021-12-02T06:57:31ZCarotid artery stenting: current and emerging options1179-1470https://doaj.org/article/a5b7afd07f1e485297191c1e55ce6f962014-10-01T00:00:00Zhttp://www.dovepress.com/carotid-artery-stenting-current-and-emerging-options-peer-reviewed-article-MDERhttps://doaj.org/toc/1179-1470 Simon Morr,1,4 Ning Lin,1,4 Adnan H Siddiqui1–5 1Department of Neurosurgery, 2Department of Radiology, School of Medicine and Biomedical Sciences, 3Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, 4Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, 5Jacobs Institute, Buffalo, NY, USA Abstract: Carotid artery stenting technologies are rapidly evolving. Options for endovascular surgeons and interventionists who treat occlusive carotid disease continue to expand. We here present an update and overview of carotid stenting devices. Evidence supporting carotid stenting includes randomized controlled trials that compare endovascular stenting to open surgical endarterectomy. Carotid technologies addressed include the carotid stents themselves as well as adjunct neuroprotective devices. Aspects of stent technology include bare-metal versus covered stents, stent tapering, and free-cell area. Drug-eluting and cutting balloon indications are described. Embolization protection options and new direct carotid access strategies are reviewed. Adjunct technologies, such as intravascular ultrasound imaging and risk stratification algorithms, are discussed. Bare-metal and covered stents provide unique advantages and disadvantages. Stent tapering may allow for a more fitted contour to the caliber decrement between the common carotid and internal carotid arteries but also introduces new technical challenges. Studies regarding free-cell area are conflicting with respect to benefits and associated risk; clinical relevance of associated adverse effects associated with either type is unclear. Embolization protection strategies include distal filter protection and flow reversal. Though flow reversal was initially met with some skepticism, it has gained wider acceptance and may provide the advantage of not crossing the carotid lesion before protection is established. New direct carotid access techniques address difficult anatomy and incorporate sophisticated flow-reversal embolization protection techniques. Carotid stenting is a new and exciting field with rapidly advancing technologies. Embolization protection, low-risk deployment, and lesion assessment and stratification are active areas of research. Ample room remains for further innovations and developments. Keywords: carotid devices, carotid stent, embolization protection, carotid stenosis, endovascular carotidMorr SLin NSiddiqui AHDove Medical PressarticleMedical technologyR855-855.5ENMedical Devices: Evidence and Research, Vol 2014, Iss default, Pp 343-355 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical technology R855-855.5
spellingShingle	Medical technology R855-855.5 Morr S Lin N Siddiqui AH Carotid artery stenting: current and emerging options
description	Simon Morr,1,4 Ning Lin,1,4 Adnan H Siddiqui1–5 1Department of Neurosurgery, 2Department of Radiology, School of Medicine and Biomedical Sciences, 3Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, 4Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, 5Jacobs Institute, Buffalo, NY, USA Abstract: Carotid artery stenting technologies are rapidly evolving. Options for endovascular surgeons and interventionists who treat occlusive carotid disease continue to expand. We here present an update and overview of carotid stenting devices. Evidence supporting carotid stenting includes randomized controlled trials that compare endovascular stenting to open surgical endarterectomy. Carotid technologies addressed include the carotid stents themselves as well as adjunct neuroprotective devices. Aspects of stent technology include bare-metal versus covered stents, stent tapering, and free-cell area. Drug-eluting and cutting balloon indications are described. Embolization protection options and new direct carotid access strategies are reviewed. Adjunct technologies, such as intravascular ultrasound imaging and risk stratification algorithms, are discussed. Bare-metal and covered stents provide unique advantages and disadvantages. Stent tapering may allow for a more fitted contour to the caliber decrement between the common carotid and internal carotid arteries but also introduces new technical challenges. Studies regarding free-cell area are conflicting with respect to benefits and associated risk; clinical relevance of associated adverse effects associated with either type is unclear. Embolization protection strategies include distal filter protection and flow reversal. Though flow reversal was initially met with some skepticism, it has gained wider acceptance and may provide the advantage of not crossing the carotid lesion before protection is established. New direct carotid access techniques address difficult anatomy and incorporate sophisticated flow-reversal embolization protection techniques. Carotid stenting is a new and exciting field with rapidly advancing technologies. Embolization protection, low-risk deployment, and lesion assessment and stratification are active areas of research. Ample room remains for further innovations and developments. Keywords: carotid devices, carotid stent, embolization protection, carotid stenosis, endovascular carotid
format	article
author	Morr S Lin N Siddiqui AH
author_facet	Morr S Lin N Siddiqui AH
author_sort	Morr S
title	Carotid artery stenting: current and emerging options
title_short	Carotid artery stenting: current and emerging options
title_full	Carotid artery stenting: current and emerging options
title_fullStr	Carotid artery stenting: current and emerging options
title_full_unstemmed	Carotid artery stenting: current and emerging options
title_sort	carotid artery stenting: current and emerging options
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/a5b7afd07f1e485297191c1e55ce6f96
work_keys_str_mv	AT morrs carotidarterystentingcurrentandemergingoptions AT linn carotidarterystentingcurrentandemergingoptions AT siddiquiah carotidarterystentingcurrentandemergingoptions
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Carotid artery stenting: current and emerging options

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