Carotid Artery Stenting


For the treatment of carotid stenosis, carotid artery stenting (CAS) is a viable alternative to carotid endarterectomy (CEA).

Carotid artery stenosis is a disabling condition that affects people of all ages. Because of their advanced age and many co-morbidities, the elderly are more susceptible to repeated strokes. The treatment choices for symptomatic carotid stenosis in the extremely elderly are the same as in younger patients, however, operation risk is increased.

Practical Implications-

  1. Stenting of the carotid arteries is a common treatment option for atherosclerotic carotid artery stenosis.
  2. Carotid artery stenosis is a common cause of stroke in the elderly, and stroke outcomes are heavily impacted by age.
  3. After a thorough examination of the patient and the lesion, very elderly symptomatic patients should be studied and intervention considered.

Background

Carotid artery stenosis is a common cause of stroke in the elderly, and age has a significant impact on stroke outcomes. As the average lifespan increases and medical care improves, the number of people over the age of 80 who have a great quality of life continues to rise. Carotid artery stenting (CAS) is a minimally invasive procedure for treating carotid artery stenosis that is well tolerated even in high-risk patients, such as the elderly. However, there is a scarcity of information on the procedure's outcome in symptomatic nonagenarians.

India In an aging population, stroke is the main cause of death and disability. The carotid arteries' atherosclerotic stenotic or occlusive disease is a major cause of cerebral ischemia and/or infarction. When compared to appropriate medical care, carotid endarterectomy (CEA) has been used extensively for symptomatic carotid artery stenosis as an intervention with up to a 20% absolute risk reduction in stroke after two years. 2 In the Asymptomatic Carotid Surgery Trial, however, asymptomatic individuals beyond 75 years of age did not see a clear benefit.

CEA's dangers grow with age; in one trial, patients over 85 years old had a 30-day mortality rate of 3.6 percent. 5 Carotid artery stenting (CAS) is a less invasive treatment option for patients who are at high risk for surgery. In terms of stroke prevention and primary endpoints, the results of CAS with the use of an embolic protection device are equivalent to CEA.

When is it better to have a carotid stent rather than an endarterectomy?

Carotid stenting is just as effective as endarterectomy in avoiding recurrent stroke after the procedure. However, endarterectomy still wins out when it comes to procedural safety and long-term efficacy in preventing recurrent stroke.

Conclusion:-

CEA appears to be the treatment of choice for carotid stenosis, especially in asymptomatic patients, due to its low rate of mortality and morbidity; CAS should be performed only in specific subgroups of cases, such as restenosis, previous neck surgery or radian therapy, anatomical high bifurcation, or extended lesions.

Findings of significantly calcified stenosis or a more convoluted carotid artery than expected were grounds for crossover from CAS to CEA, while causes for crossover from CEA to CAS included patient or physician preference or patient reluctance to endure general anesthesia.

Dr. Sandeep Sharma is the best acute stroke Mechanical Thrombectomy. He is an expert in both suction retrieval and stent retrieval and uses both techniques in perfect combination.

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