Pushing the boundaries of carotid artery stenosis treatment

Pushing the boundaries of carotid artery stenosis treatment

During the treatment of patients with carotid artery stenosis, various clinical challenges may arise in the acute, perioperative, and late phases. This thesis discusses several of these challenges and presents insights that may contribute to improving treatment outcomes in steno-occlusive carotid artery disease.

In the acute phase, when an ischemic stroke may occur due to a large vessel occlusion in the anterior cerebral circulation caused by a carotid artery stenosis, endovascular thrombectomy can be considered. However, the presence of a stenosis can complicate the procedure and negatively affect functional outcomes. Adjuncts such as a balloon guide catheter may offer procedural support, however this thesis demonstrates that their use provides no evident additional benefit in this patient population.

Regarding the perioperative phase, studies were conducted on the comparability of different stent types, the effectiveness of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) during logistical constraints, and the role of anticoagulation after CAS. Findings indicate that carotid stents are difficult to compare due to methodological inconsistencies in quantifying their properties, complicating the selection of the most appropriate type. Moreover, CAS should no longer be considered inferior to CEA, currently regarded as the gold standard for carotid revascularization. Additionally, the use of anticoagulants after CAS appears associated with an increased risk of in-stent restenosis, which elevates the likelihood of a new or recurrent ischemic stroke.

In the late phase, the preferred intervention technique for recurrent carotid artery stenosis was examined. In this context, CAS appears to be the preferred technique over CEA.

Dissertation: https://hdl.handle.net/11370/e467fcf9-994b-4ba0-a15c-c5feb1c08d02