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Strategies for reducing microemboli during carotid artery stenting

Lookup NU author(s): Dr Sumaira MacDonald


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Carotid stenting in standard risk patients has recently received supportive recommendations from the American Heart Association, in a guideline document endorsed by 14 societies with diverse but vested interest in carotid intervention. The procedural hazard i.e. the composite endpoint: all-stroke/death/myocardial infarction (MI) for carotid stenting and endarterectomy are equivalent, as is survival free of ipsilateral stroke for the two interventional strategies. However, the microembolic burden generated by endarterectomy and stenting is discrepant and although the fate and clinical relevance of diffusion-weighted magnetic resonance imaging new white lesions and of microembolic signals on transcranial Doppler remain disputed, empathic reasoning would suggest that technical and/or procedural modifications should be explored and employed during carotid stenting in order to try addressing microemboli. This article seeks to define those procedural steps likely to be associated with microemboli during carotid stenting and thus provide avoidance manoeuvres and/or possible solutions.

Publication metadata

Author(s): Macdonald S

Publication type: Article

Publication status: Published

Journal: Journal of Cardiovascular Surgery

Year: 2012

Volume: 53

Issue: suppl. 1

Pages: 23-26

Print publication date: 01/02/2012

ISSN (print): 0021-9509

ISSN (electronic): 1827-191X

Publisher: Edizioni Minerva Medica