Sasko Kedev MD — Solving problems with Carotid Artery Stenting

1. Solving problems with
Carotid Artery Stenting
Sasko Kedev MD, PhD, FESC, FACC
University Clinic of Cardiology
Skopje, Macedonia

4. CAS or CEO ?
Why surgeons are so
interested to learn CAS ?

5. CREST: “A light in the shadows of carotid
artery stenting”
C.Setacci, P De Rango . Editorial EJVES 2010 May

7. Primary Endpoint ≤ 4 years
(any stroke, MI, or death within peri-procedural period
plus ipsilateral stroke thereafter)

8. Primary outcome - 4 year

9. Primary Endpoint: peri-procedural
components
(any death, stroke, or MI within peri-procedural period)

10. Peri - Procedural Stroke and MI

11. Peri-procedural Stroke

12. Cranial Nerve Palsies
Peri-procedural

13.  CEA and CAS have similar net outcomes
though the individual risks vary, lower stroke
with CEA and lower MI with CAS
 Younger patients may have improved efficacy
with CAS and older patients have improved
efficacy with CEA

14.  At experienced centers both CEA and CAS
appear to have low perioperative complications
and excellent longer-term results
 For the future, both CEA and CAS appear to be
useful tools for preventing stroke

15. Paris, 27 May 2010
I do nowadays more stenting
than endarterectomy
Carlo Setacci
Vascular and Endovascular Surgery Unit
University of Siena
Siena - Italy

16. CEA or CAS
without influencing the choice for the most
appropriate treatment for each individual patient,
offering the greatest benefit

17. CEA or CAS
of treatment
How to choose the right option?
- RCT
- Personal experience
- Individual patient strategy
I can offer both options

18. Protective Factor
The only protective factor was
found in the operator’s experience
> 100 CAS (OR =0.81; CI:0.67-0.95)
Stroke. 2010;41:1259-1265

19. RICA after CEA + CABGcase 1.

20. RICA after CEA + CABG

22. RICA

23. HSI 7F

24. Final

25. TUA for CAS of LICA with
contralateral occlusion
Male
J. A.
66 y.o.
Case
2.

26. RICA 100%

27. Destination sheath 6Fr

28. Final Result

29. Before / After

30. Before / After

31.  Anatomical considerations
 Age
 Visible intraluminal thrombus
 Minor stroke
 No clear credentials
 Can be performed by everybody with access to cath lab
CAS DISADVANTAGES

32. CAS or CEO ?

33. CAS or CEO ?
COMPLEMENTARY
Not exclusive
but