An Update on Carotid Stent Trials and Perspectives

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Abstract

The presence of carotid artery stenosis is associated with an increased risk of stroke. Carotid endartectomy (CEA) has been demonstrated to reduce the stroke risk in standard-risk patients with symptomatic carotid stenosis as well as in asymptomatic patients, provided that the operative risk is low. The role of percutaneous carotid intervention is less clear. There are no trials that compare percutaneous carotid intervention with medical management. Although trial results comparing CEA with carotid artery stenting (CAS) are variable and/or controversial, some trials have demonstrated promising results and have fostered enthusiasm for the performance of ongoing trials comparing CAS with CEA. This article focuses on the results of completed trials and outlines ongoing and planned trials that aim to clarify the role of CAS in patients with carotid stenosis. In addition, potential unresolved problems associated with CAS, such as CAS in the elderly, in-stent restenosis and distal embolisation, are discussed.

Disclosure
Stefan Bertog, Marius Hornung, Jennifer Franke and Nina Wunderlich have no conflicts of interest to declare. Horst Sievert receives consulting fees, travel expenses or study honoraria from Abbott, Access Closure, AGA, Angiomed, Ardian, Arstasis, Avinger, Boston, Bridgepoint, CardioKinetix, CardioMEMS, Coherex, Cordis, CSI, Edwards, EndoCross, EndoTex, ev3, FlowCardia, Gore, Guidant, Invatec, Lumen Biomedical, Kensey Nash, Kyoto Medical, Medtronic, NDC, NMT, OAS, Occlutech, Osprey, Ovalis, Pathway, pfm, PendraCare, Percardia, Remon, Rox Medical, Sadra, Sorin, Spectranetics, SquareOne, St Jude, Terumo, Viacor, Velocimed and Xtent. In addition, he has stocks/stock options in Cardiokinetix, Access Closure, Coherex, Velocimed, CoAptus and Lumen Biomedical.
Correspondence
Horst Sievert, Cardiovascular Center Frankfurt, Seckbacher Landstrasse 65, 60389 Frankfurt, Germany. E: horstsievertmd@aol.com
Received date
26 July 2009
Accepted date
17 August 2009
Citation
ICR - Volume 4 Issue 1;2009:4(1):92-97
Correspondence
Horst Sievert, Cardiovascular Center Frankfurt, Seckbacher Landstrasse 65, 60389 Frankfurt, Germany. E: horstsievertmd@aol.com
DOI
http://dx.doi.org/10.15420/icr.2009.4.1.92
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