Risk assessment for carotid artery stenting

Abstract

Carotid artery stenting (CAS) is an effective and increasingly utilized therapy for carotid stenosis. Despite its safety, CAS does have procedural risks, which necessitates meticulous technique and careful patient selection for this procedure. A number of patient and anatomical characteristics have been shown to increase CAS risk, and recently, prediction models have been constructed to gauge individual patient risk objectively and comprehensively. This review discusses CAS risk assessment and offers a practical approach to the management of patients with carotid stenosis for which CAS is a viable treatment option.

Keywords::

• carotid artery stenting
• carotid endarterectomy
• carotid stenosis
• prognosis
• risk prediction
• stroke

Financial & competing interests disclosure

M Abu-Fadel has received Speakers’ Bureau from Abbott Vascular. K Rosenfield has received research grants from Abbott Vascular, Bard Peripheral Vascular, Medtronic/Invatec and Atrium; receiving consulting/advisory board fees from Abbott Vascular, Boston Scientific Corp, Complete Conference Management, Harvard Clinical Research Institute, Contego, Micell and Becker Ventures; having equity in Lumen Biomedical, Medical Stimulation Corp, Angioguard (Cordis) and Micell; and serving on the board of directors for VIVA Physicians (501C3). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Increasing age and symptomatic status are the two best established risk factors for adverse events following carotid artery stenting (CAS).

• A number of anatomical features including arch type, vessel tortuosity and calcification increase procedural complexity and have been shown to increase risk.

• Risk scores are available to accurately quantify patient-specific risk for CAS.

• The use of noninvasive imaging to identify plaque characteristics associated with stroke is an emerging area, and in the future, such techniques may have a role in predicting outcomes following CAS.

Notes

NYHA: New York Heart Association.