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(Stroke. 2006;37:309.)
© 2006 American Heart Association, Inc.

Advances in Stroke 2005

Advances in Interventional Neuroradiology 2005

David Pelz, MD, FRCPC; Tommy Andersson, MD; Michael Soderman, MD, PhD; Pedro Lylyk, MD Makoto Negoro, MD

From the University of Western Ontario (D.P.); the Karolinska Institute (T.A., M.S.), Stockholm, Sweden; and ENERI (P.L.), Buenos Aires, Argentina. Department of Neurosurgery (M.N.), Fujita Health University, Toyoake, Japan.

Correspondence to David Pelz, Department of Diagnostic Radiology, University Hospital, University of Western Ontario, 339 Windermere Rd, London, Ontario, Canada N6A 5A5. E-mail pelz@uwo.ca

Key Words: aneurysm • carotid arteries • intracranial arteriovenous malformations • intracranial vasospasm • stents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In the wake of the SAPPHIRE trial¹ and subsequent approval of carotid stenting (CAS) devices by the Food and Drug Administration (FDA) in the United States, CAS is poised to explode in the frequency of its application in North America. Although the results of the Carotid Revascularization Stenting versus Endarterectomy Trial (CREST), the largest randomized controlled trial comparing carotid endarterectomy to CAS, are years away, many practitioners in multiple disciplines have already entered the competition for patients and remuneration. Despite the absence of evidence to support CAS over carotid endarterectomy^2,3 and the need to continue recruiting patients to CREST,⁴ cardiologists, vascular surgeons, neurologists, neurosurgeons, general interventional and neurointerventional radiologists are all vying to treat carotid stenoses, many of which are <70% in severity, and asymptomatic.^2,5,6 Attempts are being made to establish training, competency and credentialing standards for performance of CAS, and they vary widely between specialties.^7,8,9 Computer simulations are playing a larger role in this process¹⁰ and may help to address the mismatch between training opportunities and interested practitioners. There have been concerns about the SAPPHIRE trial¹¹ and the incidence of restenosis in previous case series.^3,12 The techniques of CAS are still variable, with some operators advocating the use of cerebral protection devices,¹³ whereas others found that distal emboli might be more common with their usage.¹⁴ Although abnormalities on diffusion-weighted MRI after CAS are not uncommon (up to 30% of patients), most of these are asymptomatic.¹⁵ Patient related risk factors might be important determinants of complication rates after CAS, with . . . [Full Text of this Article]