A systematic review of carotid stent design and selection: strategies to optimize procedural outcomes

摘要

Carotid artery stenting (CAS) is gaining popularity as an alternative to carotid endarterectomy (CEA) in select high-risk patients with internal carotid artery (ICA) stenoses [1,2]. At present, CEA is the gold standard intervention in most patients with moderate-to-severe ICA stenosis in both asymptomatic and symptomatic populations [3-6]. CAS has not achieved equipoise when compared with CEA due to a higher stroke and death rate in most studies [1,7-11]. Of all the studies, the best results were achieved when experienced operators were used as part of the study inclusion criteria [1]. Comparable stroke and death rates were demonstrated in the SPACE trial results at 2 years [12]. However, in the original analysis of the SPACE trial, CAS did not meet its objective of noninferiority at 30 days.