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(Stroke. 2005;36:211.)
© 2005 American Heart Association, Inc.

Advances in Stroke 2004

Stroke Review

Advances in Interventional Neuroradiology 2004

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

From the Department of Neuroradiology (D.P.), University of Western Ontario, London, Canada; the Karolinska Institute (T.A., M.S.), Stockholm, Sweden; the Department of Interventional Neuroradiology and Neurosurgery (P.L.), Clinica Medica Belgrano, Buenos Aires, Argentina; and Intervascular Neurosurgery (M.N.), Fujita Health University, Japan.

Correspondence to Dr David M. Pelz, Director, University of Western Ontario, Neuroradiology, London, Ontario, Canada. E-mail cathy.lockhart@lhsc.on.ca

Key Words: Advances in Stroke • cerebrovascular disorders • endovascular therapy • intracranial aneurysm • intracranial arterial disease • radiology

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

	Introduction

 
The year 2004 in interventional neuroradiology has been distinguished by the steady accumulation of evidence to validate the efficacy of therapeutic procedures, such as carotid angioplasty and stenting (CAS) for cerebrovascular atherosclerosis. There is increasing momentum to design trials that will validate the role of endovascular therapy in the treatment of acute stroke and other cerebrovascular disorders. Practice patterns continue to evolve as evidence-based principles are applied to interventional therapy.

	Carotid Stenting

 
In September 2004, the US Food and Drug Administration approved the use of stents for the treatment of atherosclerotic disease of the carotid bifurcation. This approval was based on data from the industry-supported Acculink for Revascularization of Carotids in High Risk patients (ARCHeR)¹ registry and the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial.² ARCHeR showed a 10% complication rate for CAS in 581 high-risk patients compared with a 15% complication rate derived from the carotid endarterectomy (CEA) literature. SAPPHIRE was a randomized control trial (RCT) comparing CAS to CEA in 334 high-risk patients. Primary end points were the cumulative incidence of death, stroke, or myocardial infarction within 30 days and death or ipsilateral stroke between 31 days and 1 year. The overall rate of primary end points was 39% lower in the CAS group, and CAS resulted in complication rates for all adverse events CEA in both symptomatic and asymptomatic patients. The authors believe they have proven their hypothesis that CAS with distal protection is not inferior to CEA in high-risk patients. Criticisms . . . [Full Text of this Article]