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Printable Handouts
Navigable Slide Index
- Introduction
- Disclosures
- Ischemic stroke
- Carotid stenosis
- CEA for symptomatic carotid stenosis
- NASCET
- NASCET: 70-99% symptomatic carotid stenosis
- NASCET: perioperative stroke & death rate
- NASCET: moderate stenosis
- NASCET: 50-69% symptomatic carotid stenosis
- NASCET: moderate stenosis perioperative stroke & death rate
- NASCET: moderate stenosis gender effect
- Risk of stroke in women lower than men
- CEA for asymptomatic carotid stenosis
- ACAS
- ACAS: asymptomatic ≥60% carotid stenosis
- ACAS: perioperative stroke & death rate
- ACAS: gender effect
- Criticisms of ACAS (1)
- Criticisms of ACAS (2)
- ACST
- ACST: ≥60% asymptomatic carotid stenosis
- ACST: perioperative stroke & death rate
- ACST: gender effect
- ACST: a reduction in absolute risk of stroke
- CEA vs. CAS trials
- CEA vs. CAS: trials before CREST: SAPPHIRE
- Trials before CREST: EVA-3S
- Trials before CREST: SPACE
- CREST
- CREST: symptomatic ≥70% or asymptomatic ≥80% stenosis
- CREST: stroke or death & periprocedural rates
- CREST: MI as primary endpoint
- Effect of MI vs. stroke
- CREST: effect of age
- CREST: effect of gender
- CREST: effect of sympomatic status
- CREST: restenosis or occlusion
- CREST: costs (1)
- CREST: costs (2)
- CREST: variations in technique?
- General vs. regional anesthesia (1)
- General vs. regional anesthesia (2)
- Standard vs. eversion technique
- Eversion technique
- Standard vs. eversion technique: EVEREST
- Standard vs. eversion technique: SPACE
- Routine vs. selective shunting
- Routine vs. selective shunting: Chochrane analysis
- Routine vs. selective shunting: perioperative stroke rate
- Patch vs. primary closure: Cochrane analysis
- Patch vs. primary closure
- CREST: variations in technique?
- CAS: distal protection
- CAS: pre-stent angioplasty
- CAS: stenting
- CAS: post-stent angiogram
- (My) Indications for CAS
- (My) Contraindications for CAS
- Carotid angioplasty and stenting
- Carotid stent for dissection (1)
- Carotid stent for dissection (2)
- Acute carotid occlusion: case study part 1
- Acute carotid occlusion: case study part 2
- Acute carotid occlusion: case study part 3
- Acute carotid occlusion: case study part 4
- Cerebral hyperperfusion syndrome: case study part 1
- Cerebral hyperperfusion syndrome: case study part 2
- Cerebral hyperperfusion syndrome: case study part 3
- CREST-2 (1)
- CREST-2: asymptomatic (within 180 days) ≥70% carotid stenosis
- CREST-2: parallel study design
- CREST-2 (2)
- CREST-2: procedural credentialing
- Conclusions
- Thank you
Topics Covered
- Introduction to carotid stenosis
- NASCET trial
- ACAS trial
- ACST trial
- CREST trial
- CEA: general vs. regional anesthesia
- CEA: standard vs. eversion technique
- CEA: routine vs. selective shunting
- CEA: patch vs. primary closure
- CAS: variations in technique
- Indications and contraindications for CAS
- Carotid dissection
- Acute carotid occlusion
- Cerebral hyperperfusion syndrome
- CREST 2 trial
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Hoh, B. (2020, April 29). Prevention: carotid endarterectomy, angioplasty, and stenting [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved October 4, 2024, from https://doi.org/10.69645/MOPJ2795.Export Citation (RIS)
Publication History
Financial Disclosures
- Brian Hoh has no commercial/financial matters to disclose.
A selection of talks on Clinical Practice
Transcript
Please wait while the transcript is being prepared...
0:00
My name is Brian Hoh,
and I'm the James and Bridgette Marino Family Professor
and Chair of Neurosurgery in the Lillian S. Wells
Department of Neurosurgery at the University of Florida.
This chapter is on prevention,
carotid endarterectomy, angioplasty, and stenting.
0:19
I have no disclosures.
I have no commercial interests,
and there will be no discussion of non-FDA-approved for off-label devices or drugs.
0:28
Every year, nearly 800,000 people in the United States suffer a stroke.
Stroke is the third leading cause of mortality and
the leading cause of disability in the United States.
On average, every 40 seconds,
someone in the United States has a stroke,
and back in 2010,
the direct and indirect costs of stroke were over $143 billion,
factoring in inflation and the escalation of costs,
this is likely much higher today in 2019.
0:58
20 percent of strokes are due to carotid stenosis.
1:04
There were three prospective randomized clinical trials that
studied carotid endarterectomy for symptomatic carotid stenosis,
Nascet, the European Carotid Surgery Trial,
and the Veteran Affairs trial.
In this chapter, we will discuss the NASCET trial.
1:22
The North American Symptomatic Carotid Endarterectomy Trial studied
the beneficial effects of carotid endarterectomy in
symptomatic patients with high-grade carotid stenosis.
1:35
In this trial, 659 patients with greater than 70 percent symptomatic carotid stenosis
among 50 sites in North America were randomized
to optimal medical care versus carotid endarterectomy.
Life table-estimates of cumulative risk of
ipsilateral stroke at two years were determined,
and in the medical arm,
there was a 26 percent risk of stroke at two years
compared to nine percent at two years with carotid endarterectomy.
A statistically significant finding with a p-value of less than 0.001.