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Carotid Artery Stenting Today:���A Few Updating Remarks
Camilo R. Gomez, MD, MBA Director, Alabama Neurological Institute
Birmingham, Alabama
Carotid Stenting Disclaimer & Warning
Company Relationship Pharmaceutical BMS-Sanofi-Aventis Abbott Laboratories Parke-Davis Devices Alsius Corporation Boston Scientific Guidant Corporation CoAxia
Carotid Stenting ���Medicare Coverage: The Process
Carotid Stenting���SAPPHIRE (30 Days)
Yadav J et al. N Engl J Med 2004;351:1493-1501
Carotid Stenting��� SAPPHIRE (365 Days)
Yadav J et al. N Engl J Med 2004;351:1493-1501
30 Day Complication rates: Mortality = 41 (0.86%) Minor Stroke = 129 (2.72%) Major Stroke = 71 (1.49%) All Stroke = 192 (3.94%) All Stroke + Death = 241 (5.07%)
Carotid Stenting ���Acceptance by Surgical Community
Carotid Stenting ���Acceptance by Surgical Community
Carotid Stenting Paradoxical Created Behavior
“The friend of my adversity I shall always cherish most. I can better trust those who helped to relieve the gloom of my dark hours than those who are so ready to enjoy with me the sunshine of my prosperity.”
Ulysses. S. Grant
CAS Stenting���Filters for Embolic Protection
CAS Stenting���Global Impact of Protection
Roubin et al Circulation. 2001 Jan 30;103(4):532-7
Carotid Stenting��� Our Long-Term Experience
Carotid Stenting���Single Center Long-Term Experience
“No Equipment is a Substitute for Good Technique!”
CAS Stenting���Operator Skill’s: Sine Qua Non
Updated on 04/13/04
Protection Devices
Carotid Stenting���Perspective on Operator’s Skills
N 108 113
Age 66.7 70.0* Male 66% 62% Caucasian 90% 98% HTN 69% 81%* Diabetes 34% 28% MI 19% 28% CHF 7% 4% Baseline % stenosis 76% 75%
* p < 0.05
Carotid Stenting ���Wallstent Trial: Results
* p=0.036 ** p=0.049
Carotid Stenting ���Wallstent Trial: Major End-Points
Sponsor: Assistance Publique – Hospitaux de Paris
Design: Phase III, Open label, Randomized CAS vs. CEA