Carotid artery stenting: state of the art
M. T. Taliuridze,
F. B. Shukurov,
S. A. Abugov,
S. I. Bondarevsky,
D. A. Feshchenko,
D. K. Vasiliev,
N. A. Arablinsky https://doi.org/10.15829/1728-8800-2025-4582
EDN: TZUTSS
Abstract
In most developed countries, cerebrovascular accident (CVA) ranks second or third in mortality and is the leading cause of disability in adults. Ischemic stroke accounts for 70-90% of all cases of CVAs. Internal carotid artery (ICA) atherosclerosis with stenosis >50% account for 9-40% of ischemic strokes. Pharmacotherapy is the first-line treatment for patients with ICA atherosclerosis. However, some studies suggest that pharmacotherapy is ineffective in patients at high CVA risk. According to current Russian guidelines, carotid endarterectomy is the procedure of choice for patients with significant stenosis of the ICA. However, with the advances of endovascular technologies, carotid angioplasty with stenting has become an alternative revascularization option. According to the 10-year Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), the predominant difference in cerebral ischemic events after carotid angioplasty with stenting versus carotid endarterectomy occurred in the periprocedural period. However, after successful surgery, the late-term complication rates in the stenting group and the open surgery group were comparable. Thus, proper preoperative preparation of patients for ICA stenting and periprocedural management are key to improving the outcomes of endovascular intervention.
About the Authors
M. T. Taliuridze
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Petroverigsky Lane, 10, bld. 3, Moscow, 101990
F. B. Shukurov
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Petroverigsky Lane, 10, bld. 3, Moscow, 101990
S. A. Abugov
Petrovsky Russian Research Center of Surgery
Russian Federation
Russian Federation
Abrikosovsky Lane, 2, bld. 1, Moscow, 119435
S. I. Bondarevsky
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Trubetskaya str., 8, bld. 2, 119048, Moscow
D. A. Feshchenko
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Petroverigsky Lane, 10, bld. 3, Moscow, 101990
D. K. Vasiliev
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Petroverigsky Lane, 10, bld. 3, Moscow, 101990
N. A. Arablinsky
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Petroverigsky Lane, 10, bld. 3, Moscow, 101990
References
1. Naylor AR, Ricco JB, de Borst GJ, et al. Choice — Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(1):3-81. doi:10.1016/j.ejvs.2017.06.021.
2. Lioutas VA, Ivan CS, Himali JJ, et al. Incidence of Transient Ischemic Attack and Association With Long-term Risk of Stroke. JAMA. 2021;325(4):373-81. doi:10.1001/jama.2020.25071.
3. Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation. 2024;149(8):e347-913. doi:10.1161/cir.0000000000001209.
4. Saba L, Cau R, Murgia A, et al. Carotid Plaque-RADS: A Novel Stroke Risk Classification System. JACC Cardiovasc Imaging. 2024;17(1):62-75. doi:10.1016/j.jcmg.2023.09.005.
5. Piegza M, Jaworska I, Piegza J. Cognitive Functions after Carotid Artery Stenting-1-Year Follow-Up Study. J Clin Med. 2022; 11(11):3019. doi:10.3390/jcm11113019.
6. Matchin YG, Mitroshkin MG, Ezhov MV. Intravascular Ultrasound Examination of Coronary Arteries. Doctor.Ru. 2011;(7):12-20. (In Russ.)
7. Kazantsev AN, Khasanova DD, Alpatskaya AD, et al. CarotidSCORE.RU — risk stratification for complications after carotid endarterectomy. Russian Journal of Cardiology. 2022;27(5):5031. (In Russ.) doi:10.15829/1560-4071-2022-5031.
8. Sukhareva AV, Raikonen VA, Lenskaia SV, et al. Carotid endarterectomy in Russia. What if current guidelines do not answer difficult questions? Russian Journal of Cardiology. 2023;28(1): 5293. (In Russ.) doi:10.15829/1560-4071-2023-5293.
9. Chernyavsky MA, Komakha BB, Zherdev NN, et al. Annual results of carotid angioplasty with stenting and carotid endarterectomy. Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(6):518-24. (In Russ.) doi:10.17116/kardio202114061518.
10. Sautina MS, Sokolova AS, Butorina AS, et al. "Festina lente" — a multicenter study on the outcomes of carotid endarterectomy, depending on vessel suturing speed. Russian Journal of Cardiology. 2023;28(2):5309. (In Russ.) doi:10.15829/1560-4071-2023-5309. EDN: CFAUBH.
11. AbuRahma AF, Avgerinos ED, Chang RW, et al. Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease. J Vasc Surg. 2022;75(1S):4S-22S. doi:10.1016/j.jvs.2021.04.073.
12. Bonati LH, Dobson J, Featherstone RL, et al; International Carotid Stenting Study investigators. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet. 2015;385(9967):529-38. doi:10.1016/S0140-6736(14)61184-3.
13. Brott TG, Howard G, Roubin GS, et al. Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis. N Engl J Med. 2016;374(11):1021-31. doi:10.1056/nejmoa1505215.
14. Rosenfield K, Matsumura JS, Chaturvedi S, et al. Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis. N Engl J Med. 2016;374(11):1011-20. doi:10.1056/nejmoa151570.
15. Saratzis A, Naylor R. 30 Day Outcomes After Carotid Interventions: An Updated Meta-analysis of Randomised Controlled Trials in Asymptomatic Patients. Eur J Vasc Endovasc Surg. 2022;63(1): 157-8. doi:10.1016/j.ejvs.2021.10.029.
16. Mayoral Campos V, Guirola Ortiz JA, Tejero Juste C, et al. Carotid artery stenting in a single center, single operator, single type of device and 15 years of follow-up. CVIR Endovasc. 2018;1(1):3. doi:10.1186/s42155-018-0008-2.
17. Reiff T, Eckstein HH, Mansmann U, et al.; SPACE-2 Investigators. Carotid endarterectomy or stenting or best medical treatment alone for moderate-to-severe asymptomatic carotid artery stenosis: 5-year results of a multicentre, randomised controlled trial. Lancet Neurol. 2022;21:877-88. doi:10.1016/S1474-4422(22)00290-3.
18. Wu S, Wang H, Guo J, et al. Comparative on the effectiveness and safety of different carotid endarterectomy techniques: a single-center Retrospective Study. J Cardiothorac Surg. 2024;19:338. doi:10.1186/s13019-024-02838-0.
19. Evered L, Silbert B, Knopman DS, et al. The Nomenclature Consensus Working Group. Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery — 2018. Anesthesiology. 2018;129(5):872-9. doi:10.1097/ALN.000000000000233.
20. Wardlaw JM, Chappell FM, Best JJ, et al. Non-invasive imaging compared with intra-arterial angiography in the diagnosis of symptomatic carotid stenosis: a meta-analysis. Lancet. 2006;367(9521):1503-12. doi:10.1016/S0140-6736(06)68650-9.
21. Roubin GS, Iyer S, Halkin A, et al. Realizing the Potential of Carotid Artery Stenting: Proposed Paradigms for Patient Selection and Procedural Technique. Circulation. 2006;113(16):2021-30. doi:10.1161/circulationaha.105.59551.
22. Ross N, Barbara R, Stefano A, et al. Editor's Choice — European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg. 2023;65(1). doi:10.1016/j.ejvs.2022.04.011.
23. Ansel GM, Hopkins LN, Jaff MR, et al. Safety and effectiveness of the INVATEC MO.MA® proximal cerebral protection device during carotid artery stenting: results from the ARMOUR pivotal trial. Catheter Cardiovasc Interv. 2010;76(1):1-8. doi:10.1002/ccd.22439.
24. Montorsi P, Caputi L, Galli S, et al. Carotid Wallstent Versus Roadsaver Stent and Distal Versus Proximal Protection on Cerebral Microembolization During Carotid Artery Stenting. JACC Cardiovasc Interv. 2020;13(4):403-14. doi:10.1016/j.jcin.2019.09.007.
25. Tekieli L, Kablak-Ziembicka A, Dabrowski W, et al. Imaging modality-dependent carotid stenosis severity variations against intravascular ultrasound as a reference: Carotid Artery intravasculaR Ultrasound Study (CARUS). Int J Cardiovasc Imaging. 2023; 39(10):1909-20. doi:10.1007/s10554-023-02875-1.
26. Jean-Philippe C, Holger T, Emanuele B, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2021;42(14). doi:10.1093/eurheartj/ehaa575.
27. Osipova OS, Popova IV, Starodubtsev VB, et al. Outcomes of using various designs of carotid stents. Siberian Journal of Clinical and Experimental Medicine. 2021;36(1):30-7. (In Russ.) doi:10.29001/2073-8552-2021-36-1-30-37.
28. Wodarg F, Turner EL, Dobson J, et al; Carotid Stenosis Trialists’ Collaboration. Influence of stent design and use of protection devices on outcome of carotid artery stenting: a pooled analysis of individual patient data. J Neurointerv Surg. 2018;10(12):1149-54. doi:10.1136/neurintsurg-2017-013622.
29. Mishra B, Pandit AK, Miyachi S, et al. Clinical Utility of Intravascular Ultrasound (IVUS) in Carotid Artery Interventions: A Systematic Review and Meta-analysis. J Endovasc Ther. 2022;29(5):678-91. doi:10.1177/15266028211064824.
30. Lai R, Snyder KV, Baig A, et al. Residual In-stent Carotid Stenosis and Cigarette Smoking are Predictors of Restenosis After Stenting (CAS). Neurosurgery. 2024;70(Suppl_1):157-8. doi:10.1227/neu.0000000000002798.
31. Ning Y, Dardik A, Song L, et al. Carotid Revascularization Improves Cognitive Function in Patients with Asymptomatic Carotid Artery Stenosis. Ann Vasc Surg. 2022;85:49-56. doi:10.1016/j.avsg.2022.04.044.
32. Osipova OS, Gostev AA, Bugurov SV, et al. Asymptomatic cerebral ischemia after carotid artery stenting as a predictor of cognitive impairment. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2025;29(1):7-17. (In Russ.) doi:10.21688/1681-3472-2025-1-7-17.
33. Genkel VV, Shaposhnik II. Carotid Wall Shear Rate as a Marker of Systemic Atherosclerosis and Atherosclerotic Cardiovascular Disease. Kardiologiia. 2019;59(5):45-52. (In Russ.) doi:10.18087/cardio.2019.5.2581.
34. Taimanuly O, Sagatov IE, Uteuliev ES, et al. Stent Thrombosis in Patients with Ischemic Heart Disease: Classification, Causes, and Treatment Methods. Systematic Review. Bulletin of KazNMU. 2017;(4):52-6. (In Russ.)
35. Endara-Mina J, Escudero CJ, Carreño K, et al. Carotid Stenosis and Cognitive Function: An Update on Therapeutic Interventions. Cureus. 2025;17(4):e81908. doi:10.7759/cureus.81908.
What is already known about the subject?
- Carotid endarterectomy has been the "gold standard" for the surgical treatment of hemodynamically significant carotid artery stenosis.
- Long-term outcomes of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) demonstrate comparable efficacy and safety of carotid angioplasty with stenting and carotid endarterectomy in the long term.
- The main risks of carotid angioplasty with stenting are associated with periprocedural cerebral events due to microembolization.
What might this study add?
- This review systematizes current data, emphasizing the key importance of intraoperative imaging (intravascular ultrasound) and the choice of embolic protection to minimize the stenting risks.
- The role of novel risk stratification systems, such as Plaque-Reporting And Data System (Plaque-RADS), and the impact of revascularization on patient cognitive function are discussed.
- There is a need for a multidisciplinary approach and individual choice of revascularization approach based on anatomy, risks and experience of the center.
Review
For citations:
Taliuridze M.T., Shukurov F.B., Abugov S.A., Bondarevsky S.I., Feshchenko D.A., Vasiliev D.K., Arablinsky N.A. Carotid artery stenting: state of the art. Cardiovascular Therapy and Prevention. 2025;24(12):4582. (In Russ.) https://doi.org/10.15829/1728-8800-2025-4582. EDN: TZUTSS
Views:
970
JATS XML
Email this article 
