Rational Pharmacotherapy in Cardiology

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Stroke is one of the most frequent causes  of death and permanent disability among adults. The majority of ischemic strokes  are due to atherosclerotic plaque in the internal carotid artery. Carotid endarterectomy is more effective than medical management in the prevention of stroke in patients with carotid artery stenosis. Carotid artery stenting, a less invasive revascularization strategy than  endarterectomy, is also wide-spread but it is associated with more periprocedural complications. Knowledge of risk factors of these  complications may impact treatment decisions for the individual patient, but these factors have not been extensively studied.

About the Authors

T. V. Tvorogova
Private Clinic "Family"
Russian Federation

Tatiana V. Tvorogova – MD, PhD, Chief Physician.

Textilnaya ul. 16,  Lobnya, 141730

E. S. Bulgakova
State Research Center for Preventive Medicine
Russian Federation

Elena S. Bulgakova – MD, Fellow, Department of Clinical Cardiology and Molecular Genetics.

Petroverigsky per. 10,  Moscow, 101990

F. B. Shukurov
State Research Center for Preventive Medicine
Russian Federation

Firdavs B. Shukurov – MD, Endovascular Surgeon, Department of Roentgen-Endovascular Diagnostics and Treatment (Interventional Cardiology).

Petroverigsky per. 10,  Moscow, 101990

B. A. Rudenko
State Research Center for Preventive Medicine
Russian Federation

Boris A. Rudenko – MD, PhD, Leading Researcher,  Laboratory of Roentgen-Endovascular Diagnostics and Treatment (Interventional Cardiology).

Petroverigsky per. 10,  Moscow, 101990

O. M. Drapkina
State Research Center for Preventive Medicine
Russian Federation

Oxana M. Drapkina - MD, PhD, Professor, Deputy Director for Research and Clinical Work, Head of Department of Fundamental and Applied Aspects of Obesity.

Petroverigsky per. 10,  Moscow, 101990

A. S. Shanoyan
State Research Center for Preventive Medicine
Russian Federation

Artem S. Shanoyan MD, PhD, Head of Department of Roentgen-Endovascular Diagnostics and Treatment (Interventional Cardiology).

Petroverigsky per. 10,  Moscow, 101990


1. Suslina Z.A., Varakin Y.Y. Epidemiological aspects of the study of stroke. Time to take stock. Annaly Klinicheskoy i Eksperimental'noy Nevrologii. 2007;1(2):22-8. (In Russ.) [Суслина З.А., Варакин Ю.Я. Эпидемиологические аспекты изучения инсульта. Время подводить итоги. Анналы Клинической и Экспериментальной Неврологии. 2007;1(2):22-8].

2. Stakhovskaya L.V., Kotov S.V., eds. Stroke: a guide for physicians. Moscow: Meditsinskoe Informatsionnoe Agenstvo; 2013. (In Russ.) [Стаховская Л.В., Котов С.В., ред. Инсульт: руководство для врачей. М.: Медицинское Информационное Агенство; 2013].

3. Feigin V.L., Roth G.A., Naghavi M. et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15(9):913-24.

4. Stakhovskaya L.V., Klochikhina O.A., Bogatyreva M.D., et al. Epidemiology of stroke in Russia as a result of territorial and population register (2009-2010). Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2013;5:4-10. (In Russ.) [Стаховская Л.В., Клочихина О.А., Богатырева М.Д. и др. Эпидемиология инсульта в России по результатам территориально-популяционного регистра (2009-2010). Журнал Неврологии и Психиатрии им. С.С. Корсакова. 2013;5:4-10].

5. Adams H.P., Bendixen B.H., Kappelle L.J. et al. Classification of Subtype of Acute Ischemic Stroke Definitions for Use in a Multicenter Clinical-Trial. Stroke. 1993;24:35-41.

6. Han S.W., Kim S.H., Lee J.Y. et al. A new subtype classification of ischemic stroke based on treatment and etiologic mechanism. Eur Neurol. 2007;57(2):96-102.

7. Marnane M., Duggan C.A., Sheehan O.C. et al. Stroke subtype classification to mechanism-specific and undetermined categories by TOAST, A-S-C-O, and causative classification system: direct comparison in the North Dublin population stroke study. Stroke. 2010;41(8):1579-86.

8. Amarenco P., Bogousslavsky J., Caplan L.R. et al. New approach to stroke subtyping: the A-S-C-O (phenotypic) classification of stroke. Cerebrovasc Dis. 2009;27(5):502-8.

9. Morales-Valero S.F., Lanzino G. Asymptomatic carotid artery stenosis: time to rethink our therapeutic options? Neurosurg Focus. 2014;36(1):E2.

10. Spence J.D. Management of asymptomatic carotid stenosis. Neurol Clin. 2015;33(2):443-57.

11. O'Brien M., Chandra A. Carotid revascularization: risks and benefits. Vasc Health Risk Manag. 2014;10:403-16.

12. Morr S., Lin N., Siddiqui A.H. Carotid artery stenting: current and emerging options. Med Devices (Auckl). 2014;7:343-55.

13. Kolkert J.L., Meerwaldt R., Geelkerken R.H. et al. Endarterectomy or carotid artery stenting: the quest continues part two. Am J Surg. 2015;209(2):403-12.

14. Biller J., Feinberg W.M., Castaldo J.E. et al. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Circulation. 1998;97(5):501-9.

15. White C.J., Ramee S.R. et al. Carotid artery stenting: patient, lesion, and procedural characteristics that increase procedural complications. Catheter Cardiovasc Interv. 2013;82(5):715-26.

16. White C.J. Carotid artery stenting. J Am Coll Cardiol. 2014;64(7):722-31.

17. Rothwell P.M., Eliasziw M., Gutnikov S.A. et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003;361(9352): 107-16.

18. Rothwell P.M., Gutnikov S.A. et al. Reanalysis of the final results of the European Carotid Surgery Trial. Stroke. 2003;34(2):514-23.

19. Kernan W.N., Ovbiagele B., Black H.R. et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160-236.

20. Gahremanpour A., Perin E.C., Silva G. Carotid artery stenting versus endarterectomy: a systematic review. Tex Heart Inst J. 2012;39(4):474-87.

21. Patel R.A. State of the art in carotid artery stenting: trial data, technical aspects, and limitations. J Cardiovasc Transl Res. 2014;7(4):446-57.

22. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet. 2001;357(9270):1729-37.

23. Ederle J., Bonati L.H., Dobson J. et al. Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol. 2009;8(10):898-907.

24. Bonati L.H., Ederle J., McCabe D.J. et al. Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or end-arterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol. 2009;8(10):908-17.

25. Yadav J.S., Wholey M.H., Kuntz R.E. et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351(15):1493-501.

26. SPACE Collaborative Group. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006;368(9543):1239-47.

27. Eckstein H.H., Ringleb P., Allenberg J.R. et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008;7(10):893-902.

28. Mas J.L., Chatellier G., Beyssen B. et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355(16):1660-71.

29. Mas J.L., Trinquart L., Leys D. et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol. 2008;7(10):885-92.

30. Mas J.L., Arquizan C., Calvet D. et al. Long-term follow-up study of endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis trial. Stroke. 2014;45(9):2750-6.

31. Bonati L.H., Jongen L.M., Haller S. et al. New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol. 2010;9:353-62.

32. Brott T.G., Hobson R.W. 2nd, Howard G. et al. Stenting versus endarterectomy for treatment of carotidartery stenosis. N Engl J Med. 2010;363(1):11-23.

33. Safian R.D., Bresnahan J.F., Jaff M.R. et al. Protected carotid stenting in high-risk patients with severe carotid artery stenosis. J Am Coll Cardiol. 2006;47(12):2384-9.

34. Clair D.G., Hopkins L.N. et al. Neuroprotection during carotid artery stenting using the GORE flow reversal system: 30-day outcomes in the EMPiRE Clinical Study. Catheter Cardiovasc Interv. 2011;77(3):420-9.

35. Blackshear J.L., Cutlip D.E. et al. Myocardial infarction after carotid stenting and endarterectomy: results from the carotid revascularization endarterectomy versus stenting trial. Circulation. 2011;123(22):2571-8.

36. Qureshi A.I., Kirmani J.F., Divani A.A. et al. Carotid angioplasty with or without stent placement versus carotid endarterectomy for treatment of carotid stenosis: a meta-analysis. Neurosurgery. 2005;56(6):1171-81.

37. Gurm H.S., Nallamothu B.K., Yadav J. Safety of carotid artery stenting for symptomatic carotid artery disease: a meta-analysis. Eur Heart J. 2008;29(1):113-9.

38. Murad M.H., Flynn D.N., Elamin M.B. et al. Endarterectomy vs stenting for carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg. 2008;48(2):487-93.

39. Meier P., Knapp G., Tamhane U. et al. Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials. BMJ. 2010;340:467.

40. Theiss W., Hermanek P., Mathias K. et al. Predictors of death and stroke after carotid angioplasty and stenting: a subgroup analysis of the Pro-CAS data. Stroke. 2008;39(8):2325-30.

41. Barbato J.E., Dillavou E., Horowitz M.B. A randomized trial of carotid artery stenting with and without cerebral protection. J Vasc Surg. 2008;47:760-5.

42. Macdonald S., Evans D.H., Griffiths P.D. et al. Filter-protected versus unprotected carotid artery stenting: a randomised trial. Cerebrovasc Dis. 2010;29:282-9.

43. Kastrup A., Nagele T., Groschel K. et al. Incidence of new brain lesions after carotid stenting with and without cerebral protection. Stroke. 2006;37:2312-2316.

44. Garg N., Karagiorgos N., Pisimisis G.T. et al. Cerebral protection devices reduce periprocedural strokes during carotid angioplasty and stenting: a systematic review of the current literature. J Endovasc Ther. 2009;16:412-27.

45. Jansen O., Fiehler J., Hartmann M. et al. Protection or nonprotection in carotid stent angioplasty: the influence of interventional techniques on outcome data from the SPACE Trial. Stroke. 2009;40:841-6.

46. Parodi F.E., Schonholz C., Parodi J.C. Minimizing complications of carotid stenting. Perspect Vasc Surg Endovasc Ther. 2010;22(2):117-22.

47. Rosenkranz M., Gerloff C. New ischemic brain lesions after carotid artery stenting. J Cardiovasc Surg (Torino). 2013;54(1):93-9.

48. Knur R. Technique and clinical evidence of neuroprotection in carotid artery stenting. Vasa. 2014;43(2):100-12.

49. Engelter S.T., Wetzel S.G., Bonati L.H. et al. The clinical significance of diffusion-weighted MR imaging in stroke and TIA patients. Swiss Med Wkly. 2008;138(49-50):729-40.

50. Cassese S., Ndrepepa G., King L.A. et al. Proximal occlusion versus distal filter for cerebral protection during carotid stenting: updated meta-analysis of randomised and observational MRI studies. EuroIntervention. 2015;11(2):238-46.

51. Bijuklic K., Wandler A., Warnakov Y. et al. Risk factors for cerebral embolization after carotid artery stenting with embolic protection: a diffusion-weighted magnetic resonance imaging study in 837 consecutive patients. Circ Cardiovasc Interv. 2013;6(3):311-6.

52. Evdokimova T.P., Rodionova Yu.V., Guryev M.N., et al. The effect of a carotid revascularization on cognitive function in patients with severe stenosis: A prospective, 9 months follow-up study. Interactive Cardiovascular and Thoracic Surgery. 2011;12(Suppl. 1):S23.

53. Schnaudigel S., Groschel K., Pilgram S.M. et al. New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke. 2008;39(6):1911-9.

54. Gargiulo G., Sannino A., Stabile E. et al. New cerebral lesions at magnetic resonance imaging after carotid artery stenting versus endarterectomy: an updated meta-analysis. PLoS One. 2015;10(5):e0129209.

55. Gensicke H., Zumbrunn T., Jongen L.M. et al. Characteristics of ischemic brain lesions after stenting or endarterectomy for symptomatic carotid artery stenosis: results from the international carotid stenting study-magnetic resonance imaging substudy. Stroke. 2013;44(1):80-6.

56. Russjan A, Goebell E, Havemeister S et al. Predictors of periprocedural brain lesions associated with carotid stenting. Cerebrovasc Dis. 2012;33(1):30-6.

57. Rostamzadeh A., Zumbrunn T., Jongen L.M. et al. Predictors of acute and persisting ischemic brain lesions in patients randomized to carotid stenting or endarterectomy. Stroke. 2014;45(2):591-4.

58. Pini R., Faggioli G., Fittipaldi S. et al. Inflammatory mediators and cerebral embolism in carotid stenting: new markers of risk. J Endovasc Ther. 2013;20(5):684-94.

59. Matsukawa H., Fujii M., Uemura A. et al. Pathology of embolic debris in carotid artery stenting. Acta Neurol Scand. 2015;131(4):197-202.

60. Timaran C.H., Rosero E.B., Martinez A.E. et al. Atherosclerotic plaque composition assessed by virtual histology intravascular ultrasound and cerebral embolization after carotid stenting. J Vasc Surg. 2010;52(5):1188-94.

61. Biasi G.M., Froio A., Diethrich E.B. et al. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study. Circulation. 2004;110(6):756-62.

62. Tanemura H., Maeda M., Ichikawa N. et al. High-risk plaque for carotid artery stenting evaluated with 3-dimensional T1-weighted gradient echo sequence. Stroke. 2013;44(1):105-10.

63. Patti G., Tomai F., Melfi R. Strategies of clopidogrel load and atorvastatin reload to prevent ischemic cerebral events in patients undergoing protected carotid stenting. Results of the randomized ARMYDA-9 CAROTID (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting) study. J Am Coll Cardiol. 2013;61:1379-87.

64. Nakagawa I., Wada T., Park H.S. et al. Platelet inhibition by adjunctive cilostazol suppresses the frequency of cerebral ischemic lesionsafter carotid artery stenting in patients with carotid artery stenosis. J Vasc Surg. 2014;59(3):761-7.

65. Cirbian J., Echaniz G., Gené A. et al. Incidence and timing of hypotension after transcervical carotid artery stenting: correlation with postoperative complications. Catheter Cardiovasc Interv. 2014;84(6):1013-8.

66. Ullery B.W., Nathan D.P., Shang E.K. et al. Incidence, predictors, and outcomes of hemodynamic instability following carotid angioplasty and stenting. J Vasc Surg. 2013;58(4):917-25.

67. Wu T.Y., Ham S.W., Katz S.G. et al. Predictors and Consequences of Hemodynamic Instability after Carotid Artery Stenting. Ann Vasc Surg. 2015;29(6):128-5.

68. Huang K.L., Chang Y.J., Chang C.H. et al. Impact of coexisting coronary artery disease on the occurrence of cerebral ischemic lesions after carotid stenting. PLoS One. 2014;9(4):e94280.

69. Altinbas A., Algra A., Bonati L.H. et al. Periprocedural hemodynamic depression is associated with a higher number of new ischemic brain lesions after stenting in the International Carotid Stenting StudyMRI Substudy. Stroke. 2014;45(1):146-51.

70. Ito Y., Kato N., Matsumura A. et al. Hemodynamic instability increases new ischemic brain lesions on diffusion-weighted imaging aftercarotid artery stenting. Neurol Med Chir (Tokyo). 2013;53(6):375-80.

71. Palombo G., Faraglia V., Stella N. et al. Late evaluation of silent cerebral ischemia detected by diffusion-weighted MR imaging after filter-protected carotid artery stenting. Am J Neuroradiol. м2008;29:1340-43.

72. Zhou W., Dinishak D., Lane B. et al. Long-term radiographic outcomes of microemboli following carotid interventions. J Vasc Surg. 2009;50:1314-9.

73. Bijuklic K., Wandler A., Tübler T. et al. Impact of asymptomatic cerebral lesions in diffusionweighted magnetic resonance imaging after carotid artery stenting. JACC Cardiovasc Interv. 2013;6(4):394-8.

74. Gensicke H., van der Worp H.B., Nederkoorn P.J. Ischemic brain lesions after carotid artery stenting increase future cerebrovascular risk. J Am Coll Cardiol. 2015;65(6):521-9.

75. Huang K.L., Ho M.Y., Chang C.H. et al. Impact of silent ischemic lesions on cognition following carotid artery stenting. Eur Neurol. 2011;66(6):351-8.

76. Capoccia L., Sbarigia E., Rizzo A. et al. Silent stroke and cognitive decline in asymptomatic carotid stenosis revascularization. Vascular. 2012;20(4):181-7.

77. Wasser K., Pilgram-Pastor S.M., Schnaudigel S. New brain lesions after carotid revascularization are not associated with cognitive performance. J Vasc Surg. 2011;53:61-70.

78. Akkaya E., Vuruskan E., Gul Z.B. et al. Cerebral microemboli and neurocognitive change after carotid artery stenting with different embolic protection devices. Int J Cardiol. 2014;176(2):478-83.

79. Di Gioia G., Campanale C.M. et al. Percutaneous Treatment of Recurrent In-Stent Restenosis of Carotid Artery Stenting: A Case Report and State-of-the-Art Review. Am J Case Rep. 2015;16:558-62.

80. Stolker J.M., Mahoney E.M. et al. Health-related quality of life following carotid stenting versus endarterectomy: results from the SAPPHIRE (Stenting and Angioplasty with Protection in Patients at HIgh Risk for Endarterectomy) trial. JACC Cardiovasc Interv. 2010;3(5):515-23.

81. Daou B., Chalouhi N. et al. Predictors of restenosis after carotid artery stenting in 241 cases. J Neurointerv Surg. 2016;8(7):677-9.

82. Lal B.K., Beach K.W., Roubin G.S. et al. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol. 2012;11(9):755-63.

83. Chechеtkin A.O., Koshcheev A.Y., Protskii S.V., et al. Comparative evaluation of diagnostic accuracy angiovizualizatsii methods for vertebral arteries stenookklyuziruyuschem defeat. Meditsinskaya Vizualizatsiya. 2011;6:109-17. (In Russ.) [Чечеткин А.О., Кощеев А.Ю., Процкий С.В., и др. Сравнительная оценка диагностической точности методов ангиовизуализации при стеноокклюзирующем поражении позвоночных артерий. Медицинская визуализация. 2011;6:109-17].

84. Lal B.K., Hobson R.W. 2nd, Tofighi B., et al. Duplex ultrasound velocity criteria for the stented carotid artery. J Vasc Surg. 2008;47(1):63-73.

85. Bosiers M., de Donato G., Deloose K., et al. Does free cell area influence the outcome in carotid artery stenting? Eur J Vasc Endovasc Surg. 2007;33(2): 135-41.

For citation:

Tvorogova T.V., Bulgakova E.S., Shukurov F.B., Rudenko B.A., Drapkina O.M., Shanoyan A.S. ENDOVASCULAR TREATMENT OF CAROTID ATHEROSCLEROSIS: CONCERNS AND PERSPECTIVES. Rational Pharmacotherapy in Cardiology. 2017;13(1):80-87. (In Russ.)

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