RESUMO
Recently carotid artery stenting (CAS) was upgraded in the class of recommendation among other revascularization treatments for symptomatic patients with carotid artery disease. This makes CAS potentially available to a broader range of patients. Significant evolution in CAS materials and protection devices contributed towards this improvement. Particularly in the setting of symptomatic carotid stenosis the most important cerebral protection devices available today, are the proximal protection systems. Comparing to the distal, filter-type protection devices, proximal protection systems can offer complete cerebral protection by preventing embolization of debris in the brain even before lesion crossing. In the present manuscript, we are reviewing all data regarding the efficacy of the flow-blockage proximal protection system (Mo.Ma®, Medtronic, Minneapolis, MN, US) as well as its potential advantages and drawbacks.
Assuntos
Artéria Carótida Primitiva/cirurgia , Artéria Carótida Externa/cirurgia , Estenose das Carótidas/cirurgia , Embolia Intracraniana/prevenção & controle , Stents , Terapias em Estudo , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/prevenção & controle , Contraindicações , Dispositivos de Proteção Embólica , Endarterectomia das Carótidas , Desenho de Equipamento , Filtração/instrumentação , Humanos , Incidência , Embolia Intracraniana/epidemiologia , Metanálise como Assunto , Estudos Multicêntricos como Assunto , Tamanho da Partícula , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistema de Registros , Resultado do TratamentoRESUMO
Carotid artery stenting (CAS) is nowadays considered as alternative therapeutic option to carotid endarterectomy for patients suffering from carotid artery disease. Recent studies and meta-analyses have demonstrated equal performance of carotid stenting to endarterectomy as regard as the overall adverse events (death/stroke rates), especially when periprocedural myocardial infarction and nerve pulses are also included. However, carotid stenting was inferior to endarterectomy when compared in terms of acute and late embolic events. In the present review, we collect all studies available in the published literature regarding the late embolic events. We mainly attempted to gather data regarding the silent embolic events occurring after the acute post-procedural period. We analyzed the results and reported the incidence of the problem. Finally, we aimed to identify possible causes and propose effective solutions to reduce the incidence of late embolic events.
Assuntos
Implante de Prótese Vascular/efeitos adversos , Artérias Carótidas/cirurgia , Estenose das Carótidas/cirurgia , Dispositivos de Proteção Embólica , Embolia Intracraniana , Complicações Pós-Operatórias , Stents , Estenose das Carótidas/complicações , Saúde Global , Humanos , Incidência , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/etiologia , Embolia Intracraniana/cirurgia , Fatores de TempoRESUMO
Nowadays, carotid artery stenting (CAS) offers a potential alternative to carotid endarterectomy (CEA). CAS main advantages over CEA are the less invasive approach and the almost equal performance to CEA in terms of stroke prevention and complications. One of the most important factors which played significant role to CAS evolution is the progress in design of modern materials, especially stents. Today, several types of dedicated carotid stents have specific mechanical properties, which provide stents with individual characteristics making each of them suitable for specific carotid lesions and anatomies. The present review analyses the specific design and construction of modern stents, trying to point out their particular mechanical properties and characteristics. Additionally, it presents all available data published on comparison between different stent designs with the intention to identify which carotid stent is the best option for particular patient and lesion characteristics.