Connect
MJA
MJA

Stenting for carotid artery stenosis: festina lente . . . hasten slowly

Christopher F Bladin, on behalf of the Carotid Stenting Guidelines Committee (Australia and New Zealand)
Med J Aust 2010; 193 (8): . || doi: 10.5694/j.1326-5377.2010.tb03995.x
Published online: 18 October 2010

Carotid artery stenting has a place in managing symptomatic stenosis, but only sometimes

Carotid stenosis remains one of the most readily treatable causes of ischaemic stroke. Its treatment has undergone many changes in recent years, with the advent of endovascular techniques seeming to offer great promise of a much less invasive procedure.


  • Department of Neurosciences, Box Hill Hospital (Monash University), Melbourne, VIC.



Competing interests:

Christopher Bladin has received payment from Pfizer for reviewing applications for grants and from Sanofi-Aventis to cover travel and accommodation expenses to attend a medical conference.

  • 1. Bladin CF, Davis SM, Burton K, et al. The use of percutaneous transluminal angioplasty (PTA) for the treatment of extracranial atherosclerotic vascular disease. The Australian Association of Neurologists. Aust N Z J Med 1998; 28: 654-656.
  • 2. Mas JL, Trinquart L, Leys D, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 2008; 7: 885-892.
  • 3. Eckstein HH, Ringleb P, Allenberg JR, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol 2008; 7: 893-902.
  • 4. Ederle J, Dobson J, Featherstone RL, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 2010; 375: 985-997.
  • 5. Brott TG, Hobson RW 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010; 363: 11-23.
  • 6. Ringleb PA, Allenberg J, Bruckmann H, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 2006; 368: 1239-1247.
  • 7. Bonati LH, Jongen LM, Haller S, et al. New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 2010; 9: 353-362.
  • 8. Meier P, Knapp G, Tamhane U, et al. Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials. BMJ 2010; 340: c467.
  • 9. Carotid Stenting Guidelines Committee, Bladin C, Chambers B, et al. Guidelines for patient selection and performance of carotid artery stenting. ANZ J Surg 2010; 80: 398-405.
  • 10. Carotid Stenting Guidelines Committee. Guidelines for patient selection and performance of carotid artery stenting. J Med Imaging Radiat Oncol 2009; 53: 538-545.
  • 11. Bonati LH, Dobson J, Algra A, et al. Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: prospective meta-analysis of pooled individual patient data from three randomised trials. Lancet 2010. In press.
  • 12. Rothwell PM. Carotid stenting: more risky than endarterectomy and often no better than medical treatment alone. Lancet 2010; 375: 957-959.
  • 13. Asymptomatic Carotid Surgery Trial 2. Clinical trial identifier: NCT00883402. www.acst.org.uk (accessed Aug 2010).

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.