The Presnt and Future
JACC Review Topic of the Week
Carotid Artery Stenting in Asymptomatic Carotid Artery Stenosis: JACC Review Topic of the Week

https://doi.org/10.1016/j.jacc.2019.11.054Get rights and content
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Highlights

  • Recent clinical trials have advanced the evidence supporting carotid artery stenting in asymptomatic internal carotid artery stenosis.

  • With the current evidence base, carotid artery stenting should be reimbursed for use in appropriate patients.

  • Standardization in training, data collection, and reporting should be developed and required.

Abstract

The advance of therapies to reduce the stroke impact of asymptomatic carotid artery stenosis has proved difficult over the last decade. Disagreement concerning the underlying randomized control trials has limited entry into the care arena of endovascular therapies. Recently, advances in percutaneous therapies for carotid artery disease have been reported and provide a substantial database supporting the further incorporation of endovascular-based therapies in patients who need revascularization and meet selection criteria. With a second randomized control trial now published, it is time for a re-evaluation of endovascular therapy as a component of carotid artery care. This review describes the advances in the field in the last 5 years, clarifying the current position of these therapies in the care of the patient with asymptomatic carotid artery disease.

Key Words

carotid artery
endarterectomy
stenosis
stent
stroke

Abbreviations and Acronyms

CAS
carotid artery stenting
CEA
carotid endarterectomy
CMS
Centers for Medicare & Medicaid Services
MI
myocardial infarction
MRI
magnetic resonance imaging
RCT
randomized clinical trial
TCAR
transcarotid artery revascularization
VQI
Vascular Quality Initiative

Cited by (0)

Dr. Beckman has been a consultant for Antidote Therapeutics, Amgen, AstraZeneca, Boehringer Ingelheim, Merck, Novo Nordisk, GlaxoSmithKline, and Sanofi; and has served on data and safety monitoring boards for Novartis and Bayer. Dr. Ansel has been a consultant for Medtronic, Boston Scientific, Phillips, CR Bard, Cook, Surmodics, Abbott Vascular, and W.L. Gore; and has received royalties from Cook Medical. Dr. Lyden has been a consultant for Endologix and PQ Bypass. Dr. Das has received honoraria from Abbott, Boston Scientific, LivMor, and National Cardiovascular Partners; has been a consultant for Abbott, Boston Scientific, Cardinal Health, and National Cardiovascular Partners; is a stockholder in Janacare and LivMor; and has received research funding from Boston Scientific and LivMor.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.