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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EWhen the carotid artery becomes occluded by atherosclerotic plaques such that a narrowing, or stenosis, is observed, a patient is diagnosed with carotid artery disease. Carotid artery stenosis (CAS) can lead to many neurological conditions including dizziness, numbness, confusion and ultimately stroke. Whether to remove the stenoic plaque surgically, or use a carotid stent has been widely debated, and this article discusses the safety of carotid stents and when they should be used.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elipid disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EWhen the carotid artery becomes occluded by atherosclerotic plaques such that a narrowing, or stenosis, is observed, a patient is diagnosed with carotid artery disease. Carotid artery stenosis (CAS) can lead to many neurological conditions including dizziness, numbness, confusion and ultimately stroke. Whether to remove the stenoic plaque surgically, or use a carotid stent has been widely debated; a symposium at the AHA\u0027s Scientific Sessions discussed the safety of carotid stents and when they should be used.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003E\u201cIt is important to note,\u201d says William Gray, MD, Associate Professor of Clinical Medicine at Columbia University, \u201cthat there are no data comparing the natural history or medical therapies to carotid stenting\u2026period.\u201d Therefore, in order to compare carotid stenting to other procedures, some extrapolations must be made.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe CAPTURE (Carotid RX ACCULINK\/RX ACCUNET Post-Approval Trial to Uncover Unanticipated or Rare Events) trial, a post-market study that had 100% neurological event follow-up led by Dr. Gray, was designed to determine if carotid stenting is a safe alternative to surgery in asymptomatic patients. Data was collected from 2,500 patients from 188 medical centers who were at high risk for surgery. The study found that 94.3% of asymptomatic patients were free from major complications (death, stroke or MI) after 30 days, which is higher than numbers reported previously from surgical trials. Octogenarians had the highest event rates at 8.9%, whereas younger patient event rates were almost halved at 4.8%. Low volume operators appeared to have similar results to high volume operators and safety was more dependent on the appropriate case selection.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003ETo increase the odds of a successful procedure, Dr. Gray recommends the following strategies:\u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n               \u003Cp id=\u0022p-6\u0022\u003EPre-procedure: acetylsalicylic acid and thieneopyridine\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-7\u0022\u003EIntra-procedure: anticoagulation therapy\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n               \u003Cp id=\u0022p-8\u0022\u003EPost-procedure: discontinue anticoagulant therapy, continue antiplatelet therapy\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n               \u003Cp id=\u0022p-9\u0022\u003EFor the management of carotid body stimulation, early ambulation appears to be important\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EFor stroke prevention in carotid stenting procedures, Dr. Gray emphasizes the following;\u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n               \u003Cp id=\u0022p-11\u0022\u003EAppropriate patient\/lesion selection (type III arches, and retroflexed LCCAs are probably not good candidates for stenting due to decreased anatomical access)\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n               \u003Cp id=\u0022p-12\u0022\u003EUse of appropriate anticoagulant\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n               \u003Cp id=\u0022p-13\u0022\u003ECareful access technique\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n               \u003Cp id=\u0022p-14\u0022\u003EAdequate embolic protection (when patients were predilated without embolic protection, the risk of experiencing an event increased)\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EGiven the right patient and the right operator, this minimally invasive procedure could improve outcomes in patients with CAS.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/5\/30.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm4wq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}