ABSTRACT
The ability to deploy catheters in convoluted carotid arteries or along complex stenoses has been a source of concern in early studies of endovascular therapies such as the CAVATAS trial (23), which had a success rate of only 89% using the relatively simple technique of angioplasty. Procedural failure has not proven to be problematic in recent studies, however. Of the patients treated in the Global Carotid Artery Stent Registry, 99% were considered procedural successes (7) as were 98% of the patients in a prospective case series of 528 patients from three major endovascular centers (28). Similar rates are reported in case series of patients considered to be at high risk for endarterectomy (6), which one would expect to be the most difficult to treat. Additionally, few patients referred for endovascular stenting are actually excluded from it based on readily available pre-procedure information about the stenosed carotid. This was demonstrated in the SAPPHIRE trial (26), where the randomization of a patient first required both the vascular surgeon and the interventionist to agree that the patient was a suitable candidate for either endovascular stenting or endarterectomy. Of the 413 patients who were thought to be unsuitable for one of the procedures, 406 were excluded from endarterectomy whereas only 7 were excluded from endovascular stent placement. Clearly, in this study, there was a greater willingness by the interventionists to consider treatment for a patient with carotid stenosis.
