Retour sur les dilatations-stenting des carotides

[en] Recent publications about carotid-stenting are submitted to a critical analysis. The fact that an interventional approach in asymptomatic carotid lesions generates only marginal benefit being universally admitted, it is disturbing to see that modern series devoted to carotid artery stenting include a lot of asymptomatic patients and many symptomatic patients with a degree of stenosis well below the optimal range defined in NASCET (70 to 99%). Moreover, the degree of stenosis is often calculated from an inappropriate method that overestimates the degree of stenosis. Two objections have been made about an "hyper-selection" of the patients enrolled in the NASCET study and the production of ideal not realistic results, not attainable in community hospitals; both objections have been overruled. The rate of acute perioperative myocardial infarction is mentioned, both in NASCET and ECST, it is around 0.9% vs 7.5% in SAPPHIRE study. Moreover, carotid artery stenting with an embolic protection device has resulted in the production of infra-clinical cerebral micro-infarcts in 40% of the patients. Significantly, the independent study EVA-3S, devoted to symptomatic patients had to be stopped because of the high cerebral morbidity in the dilatation-stenting group. Carotid artery stenting of asymptomatic lesions is futile (and potentially harmful because of microinfarcts) while carotid artery stenting of symptomatic lesions generate emboli.

Disciplines :

Surgery

Author, co-author :

Van Damme, Hendrik ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques

Limet, Raymond ; Université de Liège - ULiège > Département des sciences cliniques > Chirurgie cardio-vasculaire et thoracique

Language :

French

Title :

Retour sur les dilatations-stenting des carotides

Alternative titles :

[en] Carotid Stenting Revisited

Publication date :

October 2006

Journal title :

Revue Médicale de Liège

ISSN :

0370-629X

eISSN :

2566-1566

Publisher :

Université de Liège. Revue Médicale de Liège, Liège, Belgium

Volume :

Issue :

Pages :

697-704

Peer reviewed :

Peer reviewed

Available on ORBi :

since 25 February 2011

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146 (3 by ULiège)

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Scopus citations^®
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