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1. Introduction
2. Stenosis of the internal carotid artery
3. Lecture outline
4. Symptoms of carotid stenosis (1)
5. A prominent posterior communicating artery
6. Symptoms of carotid stenosis (2)
7. Superficial borderzone infarction
8. Deep borderzone infarction
9. Impaired perfusion in deep borderzones
10. Other symptoms of carotid artery disease
11. Signs of carotid artery disease
12. Examination low flow retinopathy
13. Cholesterol embolus with retinal infarction
14. Indications for carotid endarterectomy
15. Stenosis treatment should be evidence based
16. Mechanisms of ischaemic stroke
17. Analysis of symptomatic carotid surgery trials
18. Different methods to measure stenosis
19. Analysis results: stenosis 70-99%
20. Angiograms of severe stenosis and near occlusion
21. Analysis results: near occlusion
22. Absolute risk reduction with surgery
23. Benefit of carotid endarterectomy
24. The effect of surgery by time since last event
25. Risk of recurrent stroke prior to endarterectomy
26. Carotid endarterectomy for asymptomatic stenosis
27. Asymptomatic carotid surgery trial
28. Main results of ACST trial
29. Carotid territory ischaemic stroke: 5-years risk
30. Combined analysis of ACST and ACASA trials
31. Benefit from surgery for asymptomatic patients
32. HPS study
33. Is angioplasty or stenting an alternative?
34. Endovascular treatment - alternative to surgery?
35. Carotid endarterectomy specimen
36. What have we learnt from CAVATAS?
37. Inflated angioplasty balloon
38. Carotids fit for surgery
39. CAVATAS results (1)
40. CAVATAS results (2)
41. Histology of restenosis after angioplasty
42. Conclusions from CAVATAS
43. Evolution of endovascular treatment
44. Self expanding nitenol stent
45. Cerebral protection devices
46. Parodi anti-embolism system
47. Disadvantages of protection devices
48. CAVATAS: timing of strokes after treatment
49. Recent prospective case series and registries
50. Problems with case series and registry data
51. Accuracy of outcome event assessment
52. Importance of randomised control trials
53. Carotid angioplasty and stenting vs. surgery
54. SAPPHIRE trial
55. SAPPHIRE trial: intention to treat analysis
56. SAPPHIRE trial: results
57. SAPPHIRE trial: notable features
58. EVA-3S trial: 30 day safety data
59. Explanations for the difference in EVA-3S
60. CAVATAS: effect of carotid angioplasty/stenting
61. SPACE: 30 day safety data
62. SPACE: notable features
63. Metanalysis of endovascular treatment vs. surgery
64. Metanalysis results: stroke or death at 30 days
65. Metanalysis results: MI, death, stroke at 30 days
66. Metanalysis results: cranial neuropathy
67. Metanalysis results: other comparisons
68. Numbers of patients included in the metanalysis
69. Endovascular vs. surgical treatment: conclusions
70. On-going trials of carotid stenting
71. Conclusions: treatment of symptomatic stenosis
72. Conclusions: endarterectomy after stroke or TIA
73. Conclusions: treatment for asymptomatic stenosis
74. Conclusions: carotid stenting
75. Acknowledgements

Topics Covered

• Symptoms and signs of carotid stenosis
• Imaging features
• Indications for carotid endarterectomy for symptomatic stenosis
• Indications for carotid endarterectomy for asymptomatic stenosis
• Are angioplasty and stenting safe and effective alternatives?

Links

Series:

• Cerebrovascular Disease

Categories:

• Clinical Practice
• Neuroscience

Therapeutic Areas:

• Neurology

Talk Citation

Publication History

• Published on October 27, 2008
• Archived on February 25, 2021

Financial Disclosures

• Prof. Martin Brown has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.