Jacqueline Saw

Equipment for Extracranial Carotid Artery Stenting

Since the first carotid angioplasty that was performed in 1980, the equipment available have evolved dramatically. Numerous catheters with different shapes for engagement of specific vessels have been introduced. Catheter and sheath construction has improved, with larger inner luminal diameter achievable without increasing the outer diameter. Thus, smaller arterial puncture may be made with lower risk of access site complications. A wide selection of guidewires have been introduced, some with hydrophilic coating and others with either flexible or stiff support for a variety of uses. Balloon catheters and stents have also evolved with lower profile, greater flexibility, and ease of deliverability. The technique of carotid artery stenting (CAS) has also progressed to routine use of emboli protection device (EPD) and self-expanding nitinol stents. These and other technological advances have improved the success and safety of CAS, with reported technical success rate of approx 99% (1), and estimated periprocedural death and stroke rate of approx 2% (see Chapter 12).

Noninvasive Imaging of the Carotid Artery

Noninvasive carotid artery evaluation is an essential tool to assess patients who are at risk of atherosclerotic carotid artery disease because digital subtraction angiography is invasive and carries a 0.3-1% risk of periprocedural transient ischemic attack or stroke. Currently, duplex ultrasound, computed tomography angiography, magnetic resonance angiography, and transcranial Doppler are available to noninvasively evaluate the severity of carotid artery disease. The relative merits and limitations of each technique are reviewed in this chapter. Key Words: Computed tomography angiography, duplex ultrasound, magnetic resonance angiography, transcranial doppler.

The Approach to Extracranial Carotid Artery Stenting

Carotid artery stenting is a high-risk procedure that requires meticulous techniques to avoid potentially devastating complications. Performance of this procedure should be limited to experienced endovascular specialist with good catheter-based techniques. This chapter guides readers through a step-by-step approach to carotid stenting.

The Approach to Intracranial and Extracranial Vertebral Artery Stenting

Approximately 25% of ischemic strokes involve the posterior or vertebrobasilar circulation, which is associated with a mortality of 20-30%. Posterior circulation strokes are predominantly due to embolism and large artery disease. This chapter focuses on the percutaneous management of patients with significant atherosclerotic stenosis of the extracranial and intracranial vertebral artery.