CardioExchange Archive

January 16th, 2014

Are All Carotid Stenting Systems Equal?

Jay Giri, MD, MPH and Robert W. Yeh, MD MSc MBA

Jay Giri and Robert W. Yeh discuss their research group’s analysis of patient-registry data on embolic protection devices that are commonly used in carotid artery stenting.

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October 24th, 2013

Surgery Preferable to Stents in Elderly People with Carotid Disease

Larry Husten, PHD

Age should play an important role in choosing a revascularization procedure for people with blocked carotid arteries, according to a new paper published in JAMA Surgery.  Carotid endarterectomy surgery (CEA) is preferable to carotid artery stenting (CAS) in elderly people; for younger patients, the two revascularization procedures are broadly similar. George Antoniou and colleagues analyzed data from 44 studies […]

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December 1st, 2011

Heart Over Head or Head Over Heart?

Anju Nohria, MD and James Fang, MD

A 52-year-old man presented with 3 episodes of transient dysarthria and right-sided facial numbness within a 2-week period. A carotid ultrasound revealed >70% stenosis of the left-internal carotid artery and 50%–69% stenosis of the right coronary artery. At age 40, the man had been diagnosed with non-Hodgkin lymphoma, which was treated with cranial radiation and anthracyclines, […]

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September 27th, 2011

Carotid Stenting: How Steep the Learning Curve?

Brahmajee Kartik Nallamothu, MD, MPH

In an observational study involving Medicare patients undergoing carotid stenting between 2005 and 2007, Dr. Brahmajee Nallamothu and colleagues showed that low annual operator volume and early experience are associated with increased 30-day mortality. CardioExchange Interventional Cardiology moderators Rick Lange and David Hillis have posed the following questions to Dr. Nallamothu: RL and DH: Did you […]

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September 9th, 2011

Asymptomatic Carotid Stenosis: Medical Management or Revascularization?

Allan Brett, MD

Every so often, one of my patients with no history of stroke or transient ischemic attack asks my opinion on what to do about a carotid ultrasound — not ordered by me — showing high-grade stenosis. I am a general internist, and I don’t obtain these studies in patients without a history of cerebrovascular symptoms. Guidelines […]

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August 18th, 2011

Are Interventionalists Getting Too Far “A Head”?

Richard A. Lange, MD, MBA and L. David Hillis, MD

Nallamothu and colleagues have performed an observational analysis of Medicare data on fee-for-service beneficiaries undergoing carotid stenting between 2005 and 2007 in 306 hospital referral regions (HRRs). First, they determined how often carotid stenting was performed by different specialists (i.e., cardiologists, surgeons, radiologists) within each HRR, then they compared utilization rates and 30-day outcomes of the procedure across HRRs. What did they find? Although […]

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May 9th, 2011

Higher Periprocedural Risk for Stroke Found in Women Undergoing Carotid Stenting

Larry Husten, PHD

The periprocedural risk for stroke is higher among women undergoing carotid artery stenting than among those undergoing carotid endarterectomy, according to new results from the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) published online in the Lancet Neurology. The same pattern was not found in men. Last year, the main results from CREST showed no overall […]

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February 1st, 2011

New Guidelines Lend More Support for Carotid Stenting

Larry Husten, PHD

Newly issued guidelines provide increased support for carotid stenting as an alternative to carotid endarterectomy, but don’t favor widespread screening or the routine use of ultrasound to assess the risk for stroke. The Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease, developed by the AHA, the ACC, and multiple other organizations, […]

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September 10th, 2010

Meta-Analysis Finds High Risk for Carotid Stenting in Older Patients

Larry Husten, PHD

Carotid stenting should not be performed in patients age 70 years or older, according to the results of a new meta-analysis appearing in the Lancet. Researchers in the Carotid Stenting Trialists’ Collaboration combined data from 3433 patients with symptomatic carotid stenosis who were randomized to either endarterectomy or stenting in the EVA-3S, SPACE, and ICSS trials. At 120 […]

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