Carotid interventions

348 Pages·2004·3.235 MB·English

by  Peter A Schneider, W Todd Bohannon, Michael B Silva

Carotid
Interventions
Carotid
Interventions
Edited by
Peter A. Schneider
Hawaii Permanente Medical Group
Honolulu, Hawaii, U.S.A.
W. Todd Bohannon
Texas Tech University Health Sciences Center
Lubbock, Texas, U.S.A.
Michael B. Silva, Jr.
Texas Tech University Health Sciences Center
Lubbock, Texas, U.S.A.
MARCEL DEKKER NEW YORK
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5932-X_Schneider_Foreword_R1_061804
Foreword
This book on carotid interventions could not have been more appropriately timed
withcurrentclinicaldevelopmentandapplicationofcarotidstentsplusprotectionasan
alternative therapy to carotid endarterectomy. The book provides a contemporary,
balanced, and expert approach to the understanding of carotid endovascular proce-
duresandcontainsinformationthatisessentialforInterventionaliststreating patients
with carotid lesions. The text is an excellent companion book to Dr. Schneider’s re-
centlypublishedEndovascularSkills:GuidewireandCatheterSkillsforEndovascularSurgery:
Second Edition and presents information related to carotid interventions that is not
contained in the companion work. The breadth and value of Dr. Schneider’s con-
tributions exemplify his level of commitment that to endovascular technologies. The
editor’s [Dr. Schneider, Adjust to include the other editors?] perspective on
endovascular methods combined with his exceptional conventional vascular surgical
technical expertise and skills provides a unique and invaluable perspective on this
evolving field.
Theinitial chapters of Carotid Interventions containareviewof neurovascular and
aortic arch anatomy, and equipment, inventory and facility requirements for carotid
angioplasty and stenting. These chapters are written by experts on the topics and are
conciseandwellillustrated.Subsequentchaptersdiscussmoreadvancedtopicssuchas
advanced cerebrovascular arteriography, access challenges for carotid interventions,
and the impact and appropriate consideration of comorbid factors in the successful
treatment of complex patients. A chapter addresses technical components of the
procedure, including a reviewof currently available and developing devices, catheters
andimagingtechnologies.Techniquestooptimizehemodynamics,recognizeandtreat
neurologicaldeficits,andreacttoclinicalproblemsthatpresentduring proceduresare
reviewed in a clinically appropriate and comprehensive manner.
iii
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iv Foreword
The final chapters of the text review data regarding the indications for and the
success of carotid angioplasty and stenting compared to surgical and medical therapy.
Thediscussionincludesanoverviewofunresolvedissues.Aparticularlyvaluable part
of the text contains technical tips for angioplasty and stenting and management of
complex issues and complications of carotid interventions. Ways to initiate a practice,
obtain and develop skills, and confront unknown issues are summarized in a com-
prehensive and responsible manner. A very useful component of the text is the Ap-
pendix,whichlistsrecommendedinventoryforcarotidvascularprocedures,containsa
reviewoftheNationalInstitutesofHeathNeurologicStrokeScale,andpresentsother
useful technical information.
The book is not only expertly written and edited but addresses an important
area of current interest in the evolution of vascular interventions. The challenges and
responsibilitiesof adoptingthisnewtechnologytotreatmentofcarotidstenosisusing
surgical methods that have been developed to exceptional levels of success under-
linetheimportanceof thiswork. Carotidangioplastyandstenting representsapartic-
ularlychallengingareaasitdirectlyaddresseshighlyfearedclinicalproblemsinvolving
stroke, paralysis, and death. This book offers a comprehensive and responsible intro-
ductionandemphasizestheadoptionandutilizationofsafemethodstogainmaximal
patientbenefit.
This multi-authored text, with many of the pivotal chapters prepared by Dr.
Schneider as sole author, represents a particularly significant contribution to the evo-
lution and practice of endovascular interventions. The text is an invaluable source of
criticalinformationthatisessentialtothedevelopment,maintenance,andresponsible
practice of carotid interventions.
Rodney A. White, M.D.
Chief of Vascular Surgery
Harbor-UCLA Medical Center
Torrance, California
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5932-X_Schneider_Preface_R1_061804
Preface
The purpose of this book is to assist the reader in the process ofidentifying, under-
standing, and improving the skills needed for incisionless treatment of carotid artery
stenoses.Ouremphasisisontechniqueandresultsbutwehaveincludedpracticaladvice
ontopicssuchashowtogetstarted,whatkindoftrainingisneeded,andhowtosafely
andefficientlyaddcarotidangioplastyandstentingtoyour therapeuticofferings.
The developing clinical utility of carotid angioplasty and stenting highlights the
importanceofabroaderissuefacingvascularsurgery.Willvascularsurgeonsbeableto
adapt and retain our role as providers offull-service vascular care? We believe that
vascular surgeons are ideally, if not uniquely, qualified to manage patients with extra-
cranialcerebrovasculardiseaseandtoassesscompetingtherapies.
Carotidstentplacementrepresentstheconvergenceofmultiplefactorsatatime
when we are rethinking our approach to vascular disease. Skills and technology de-
velopedinother,moreforgiving,vascularbedshaveimprovedoverthepastfewyears.
Carotidbifurcationatherosclerosisismoreamenabletoendovascularinterventionthan
conventionalwisdomwouldhave predicted.Distalprotectiondevicesandothertech-
nicaladvancesmaybeabletodecreasestrokeriskandmaketheneurologicaloutcome
of carotid stent placement competitive with carotid endarterectomy. Specialists in
multiple disciplines represent an eager potential workforce ready to participate in the
rapiddisseminationofcarotidstentingtoanexpandedpoolofpatients.
Among vascular surgeons, the traditional therapists of carotid occlusive disease,
manyofferonlyendarterectomyandhaveyettoperformcarotidstentplacementasan
alternativetherapyfortheirpatients.Vascularsurgeonswhohavehonedtheirabilityto
offer effective therapy for carotid disease via carotid endarterectomy, but who do not
havetheexperiencethatwouldallowthemtoparticipateintheperformanceofcarotid
angioplasty and stenting, are forced to choose between two unappealing alternatives:
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