Journal
JOURNAL OF VASCULAR SURGERY
Volume 74, Issue 6, Pages 2087-2095Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jvs.2021.05.048
Keywords
TCAR; Flow reversal; Transcarotid artery revascularization; Transcarotid artery stenting; Anatomic suitability; Carotid bifurcation; Carotid artery stenting
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This review summarizes the anatomic and morphologic characteristics of the carotid vasculature and discusses the implications for patient selection and clinical decision-making. It highlights the importance of thorough assessment to rule out unfavorable characteristics for stent placement, and suggests that carefully chosen lesions may benefit from transcarotid artery revascularization for better procedural success and long-term durability.
Objective: Over the years where stents have been used to treat carotid lesions, a great deal has been learned about which anatomic characteristics lead to adverse outcomes. This review summarizes the anatomic and morphologic characteristics of the carotid vasculature that can help guide patient selection and clinical decision-making. Methods: Each of the carotid artery anatomy and lesion characteristics that are relevant to carotid stenting is described in detail. These are accompanied with evidence-based outcomes and results. Results: Data on the prevalence of carotid artery lesions that are unsuitable for stenting are summarized and the implications of these data for practice are discussed, especially as they pertain to transcarotid artery revascularization. Conclusions: Carotid artery stenting can be a viable option for carotid revascularization, but the lesion must be acceptable and safe for stent placement. There should be thorough assessment to rule out the presence of severe tortuosity, long-segment disease, severe calcification (circumferential or exophytic), mobile plaque, swollen internal carotid artery sign, and carotid diameters outside the acceptable range. In carefully chosen lesions with the absence of the unfavorable characteristics described, transcarotid artery revascularization may offer improved periprocedural success and carotid artery stenting may attain better long-term durability.
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