Carotid artery angioplasty (2022) – online course

Description

Please note that this course is no longer CME accredited.

Authors: S. Hopf-Jensen and S. Müller-Hülsbeck

Reviewers: Z. Aldin, T. Cleveland, B. Gonçalves, C. Nice and M. Tsitskari

This course corresponds to chapter 2.2.1.1.4 Supra-aortic arterial disease in the European Curriculum and Syllabus for Interventional Radiology.

Abstract

Stroke is one of the leading causes of morbidity and mortality worldwide. Carotid artery stenting (CAS) has been established as a minimally invasive endovascular procedure for the prevention of ischaemic stroke in patients with underlying carotid artery stenosis. The first successful internal carotid artery angioplasty was described by Morris, Lechter and DeBakey in 1967 as an open technique with gradual dilatation. The first percutaneous transluminal angioplasty of the internal carotid artery was reported by Mathias in 1977. This module gives an overview of established guidelines and trials for carotid artery stenting.

Detailed knowledge of the aortic arch, cervical and intracranial vascular anatomy and physiology is important for successful diagnostic and interventional management. A structured training programme, mentoring and proctoring are essential for practice. Different steps of the intervention are described.

Refinement of patient selection criteria, standardisation of techniques with blood pressure control and adequate pharmacotherapy continue to improve the results of internal carotid artery stenting. To further reduce the incidence of embolic stroke, different devices and stents have been developed. Different stent designs (open- and closed-cell design, hybrid cell design and micromesh dual-layer design) and the impact of the procedure are discussed.

In the case of complications, physicians performing CAS must be familiar with intracranial vascular anatomy, thrombectomy devices and the use of thrombolytic agents, as well as with specific drugs.

Learning objectives

• Know how to integrate and evaluate anatomical characteristics and lesion pathology on pre-interventional non-invasive imaging
• Know how to reach technical competence performing carotid and supra-aortic interventions
• Understand current treatment algorithms for asymptomatic and symptomatic carotid artery stenosis
• Recognise the role of endovascular treatment for special indications in acute stroke such as tandem stenosis and dissection
• Understand pre-, peri- and post-procedural pharmacology requirements
• Understand the variety of available stents, angioplasty balloons, guiding catheters, wires and cerebral protection devices
• Know types and rates of expected complications of CAS and how to manage them

Further information

This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for Interventional Radiology and corresponds to chapter 2.2.1.1.4 Supra-aortic arterial disease.