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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\u003EThis article discusses carotid stenting, stroke prevention, renal failure prevention, aortic stenting, and AAA rupture prevention.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECarotid Stenting and Stroke Prevention\u003C\/h2\u003E\n         \u003Cp id=\u0022p-2\u0022\u003ETo determine if carotid stenting reduces the risk of stroke, surgical and medical therapy trials must be compared to stenting trials, since no data directly comparing the procedures are available. Although this strategy is \u201ca little imperfect,\u201d says William Gray, MD, Associate Professor of Clinical Medicine at Columbia University, \u201cit\u0027s all we have.\u201d\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/10925\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/10925\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10925\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThese data show that surgery is able to prevent stroke better than medical therapy. Additionally, comments Dr. Gray, \u201ccarotid artery stenting has demonstrated equivalent stroke prevention efficacy compared to endarterectomy.\u201d Recently published EVA-3S trial in Europe, however, found higher incidence of stroke in symptomatic patients treated with stenting than with endarterectomy (Jean-Louis Mas et al. \u003Cem\u003ENEJM\u003C\/em\u003E 2006; 355:1660\u20131671) The TACIT trial, currently under proposal, aims to directly compare medical therapy, endarterectomy and stenting.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ERenal Failure Prevention\u003C\/h2\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EProgressive renal artery stenosis (RAS) is a problem, according to Chris White, MD, Chairman of the Department of Cardiology and Director of the Ochsner Heart \u0026amp; Vascular Institute in New Orleans, \u201cI think it\u0027s actually quite dangerous to sit here and watch RAS progress.\u201d He adds that conservative medical therapy could lead to progression and eventually occlusion. Indeed, in the DRASTIC (Dutch Renal Artery STenosis Intervention Cooperative) trial, balloon angioplasty and medical therapy in RAS lead to 0% and 16% of patients suffering from occlusion, respectively. Finally, occlusion typically leads to renal failure. Renal artery stenosis has high prevalence in patients with coronary artery disease and confers additional mortality, making a case for screening high risk patients undergoing cardiac catherization for presence of renal artery stenosis (White CJ et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2006; 114(17):1892\u20131895).\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EPatient selection is important for success in preventing RAS. Murray et al demonstrated that the more rapid the decline in renal function, the more likely the patient is to benefit from revascularization (Murray S et al. \u003Cem\u003EAm J Kidney Dis\u003C\/em\u003E 2002; 39:60). Additionally, to avoid complications, embolic protection devices are recommended (though none of the devices are approved for use in renal arteries).\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003E\u201cBenign neglect of RAS is not benign,\u201d summarizes Dr. White, \u201cyou cannot treat patients with medical therapy and assume that because you are controlling the blood pressure you are not losing renal function.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAortic Stenting and AAA Rupture Prevention\u003C\/h2\u003E\n         \u003Cp id=\u0022p-7\u0022\u003E\u201cLife really changed in September of 1999 when the FDA approved two graft prostheses,\u201d says Alan Lumsden, MD, Professor and Chief of the Division of Vascular Surgery at Baylor College of Medicine in Houston, when referring to the Guidant Bifurcated Endograft and the AneuRx Stent Graft System. Since then, many devices have emerged around the same concept and have shown significant promise.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EIn the US AneuRx trials, freedom from rupture was 98.4%, and freedom from aneurysm related death was 96.9%. The key to success, says Dr. Lumsden, is patient selection, with the single most important criteria being neck diameter (\u226426mm). Problems arise when a patient presents with a short, tapered neck. Therefore, pre-procedure planning involving a CT scan of the abdomen to calculate neck diameter, is critical.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003E\u201cGood anatomy equals good results when you\u0027re treating patients with a stent graft,\u201d says Dr. Lumsden, adding, \u201cWe must understand and respect anatomical limits, practice careful follow-up, and understand the nuances of each device.\u201d\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\/31.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\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm4wq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}