Anatomic criteria in the selection of treatment modality for atherosclerotic carotid artery disease.

Journal of Vascular Surgery
Norman H KuminsVikram S Kashyap

Abstract

Three procedures are currently available to treat atherosclerotic carotid artery stenosis: carotid endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and transcarotid artery revascularization (TCAR). Although there is considerable debate evaluating each of these in a head-to-head comparison to determine superiority, little has been mentioned concerning the specific anatomic criteria that make one more appropriate. We conducted a study to define anatomic criteria in relation to inclusion and exclusion criteria and relative contraindications. A retrospective review was conducted of 448 carotid arteries from 224 consecutive patients who underwent a neck and head computed tomography arteriography (CTA) scan before carotid intervention for significant carotid artery stenosis. Occlusion of the internal carotid artery (ICA) occurred in 15, yielding 433 arteries for analysis. Anatomic data were collected from CTA images and demographic and comorbidities from chart review. Eligibility for CEA, TF-CAS, and TCAR was defined on the basis of anatomy, not by comorbidity. CTA analysis revealed that 92 of 433 arteries (21%) were ineligible for CEA because of carotid lesions extending cephalad to the second cervical vertebra. ...Continue Reading

Citations

Aug 20, 2020·Stroke; a Journal of Cerebral Circulation·Andreia CoelhoGert J de Borst
Oct 7, 2020·Expert Review of Cardiovascular Therapy·Olesya OsipovaAndrey Karpenko
Jul 21, 2021·Stroke; a Journal of Cerebral Circulation·Nadin ElsayedMahmoud B Malas
Jun 22, 2021·Annals of Vascular Surgery·Nathan K ItogaManuel Garcia-Toca
Jun 28, 2021·Journal of Vascular Surgery·Angela A KokkosisPeter A Schneider

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