Vascular Solutions

Carotid Stenting has emerged as an alternative method for treating hemodynamically significant carotid arterial disease. The first attempts at endovascular treatment involved angioplasty but had very high complications rates. Stents were then adapted with better success but still had a relatively high stroke complication rate. Cerebral protection devices were developed to catch clots and debrie that are disrupted from the carotid artery during the procedure. In the last half of 2004 the FDA approved a carotid stent and cerebral protection device marketed by Guidant for "high risk patients with a symptomatic internal carotid stenosis that exceeds 50% or an asymptomatic internal carotid stenosis that exceeds 80%. Medicare, however, only covers high risk patients with > 70% ICA stenosis that are symptomatic.

Carotid stenting appears to be a safe procedure based on reports from the New England Journal of Medicine and other publications. However, recently some articles have begun to challenge the perceived results of this less invasive procedure. The multicenter Carotid Revascularization Endarterectomy vs. Stent Trial (CREST) supported by the National Institute of Neurological Disorders has entered into a randomized study to analyze this issue. Recently they published an article in Journal of Vascular Surgery (Dec. 2004) which found an increased risk of carotid stenting in patients over 80 years of age. No one therapy is perfect and thus must be appropriately selected for an individual patient.

Vascular Solutions offers carotid stenting for high risk patients with symptomatic carotid disease and an ICA stenosis that exceeds 70%. Vascular Solutions offers Carotid Stenting at Geauga Regional Hospital and Parma Community General Hospital. Vascular Solutions strongly supports patient education and understanding of options, risks and complications. We recommend that all patients review with their doctors these issues before accepting treatment for any condition including carotid arterial disease. Vascular Solutions will offer carotid stenting to our patients under the appropriate clinical conditions.

General Overview and discussion of the natural history, risks and benefits for treatment of Carotid Arterial Disease.

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Web Site by Mark Goldberg, MD

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