Matching the anatomy with the technique and vascular approach in carotid artery stenting. The role of systematic multidetector CT angiography

摘要

Carotid artery stenting (CAS) is a widely accepted treatment for carotid artery disease. The systematic use of distal cerebral protection substantially improved both the safety and efficacy of CAS, leading to consistent improvements in registry and randomized control trial results, including "high-surgical-risk" patients. As the clinical experience of CAS accumulated, interventionists realized that the vascular anatomy below the carotid bifurcation rather than the stenosis itself represented the true limiting factor of the procedure. Severe aortoiliac disease, unfavorable aortic arch configuration (type ll-lll and/or diseased aortic arch), variants (bovine arch), and supra-aortic vessel takeoff and course are the conditions that more frequently make CAS difficult.