1. Carotid Artery Stenting Predictors of procedural and clinical success
Mehmet Cilingiroglu, MD ,FSCAI, FACC, FESC
Arkansas Heart Hospital
Little Rock, AR

2. Disclosures
I, Mehmet Cilingiroglu, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

3. Development of CAS Technology
PTA of the internal carotid artery was first reported 30 years ago.
CAS with or without embolic protection devices was described 15 years later.
CAS was initially developed as alternative therapy for patients that were deemed high surgical risk (SAPPHIRE).

4. High Risk Features for CEA

5. Carotid artery stenting
Declining risk of stroke and death with carotid stenting. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
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Catheterization and Cardiovascular Interventions Volume 82, Issue 5, pages , 9 AUG 2013 DOI: /ccd

6. Variables that increase risk of CAS
Patient characteristics
Anatomic/ lesion features
Procedural factors
Sources:
Baim D., Grossman W., ed. Grossman’s Cardiac Catheterization, Angiography, and Intervention. Philadelphia, PA; Lippincott Williams & Wilkins: 2000.
Brundage B., ed. Comparative Cardiac Imaging: Function, Flow, Anatomy and Quantitation. Rockville, MD; Aspen Publishers: 1990.
Conti C. “Selective Coronary Angiography: 42 Years Later.” Clin Cardiol 24, (2001).
Pepine C., Hill J., ed. Diagnostic and Therapeutic Cardiac Catheterization. Baltimore, MD; Williams & Wilkins:

7. High Risk Patient and Lesions
Age >80 years
Decreased cerebral reserve (dementia, multiple prior strokes, intracranial microangiopathy)
Excessive tortuosity (more than 90° turn in 5 cm of the target lesion)
Heavy calcification (Concentric calcification more than 3 mm in width)
Near total occlusions
Thrombus containing lesions

8. High Risk Features for CAS

9. Technical factors
Prolonged catheter or guide wire manipulation in the aortic arch.
Difficulty crossing carotid stenosis.
Unsuccessful deployment or retrieval of embolic protection devices.
Difficulty stent delivery or placement.

10. High Risk Anatomic Features for CAS

11. High Risk Carotid artery stenting
Type III Arch
Long Lesion Length
Type III aortic arch.
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12. High Risk Patient and Lesions

13. CAS outcomes in selected elderly patients

14. CAS complication rate between Specialists

15. Carotid Artery Stent Designs
Open Cell
Closed Cell

16. Conclusion
In experienced centers, with experienced operators, CAS can be performed with low periprocedural events.
Patient characteristics, anatomical and lesion features and procedural factors will need to be carefully evaluated prior to the procedure.
Ultimate outcome of the CAS in high-risk patients should be at least comparable if not better to surgery.