New Developments in Endovascular Interventions for Extracranial Carotid Stenosis

We provide an overview of recent developments in carotid interventional technique and equipment, including new stents and emboli protection devices. The newer self-expanding stents lessen the problem of external stent compression associated with balloon expandable stents, but precise deployment and the matching (by length) of stents to lesions remain problematic. We also discuss emerging pharmacologic strategies for cerebral protection in stroke. Multiple randomized clinical trials and multicenter registries are under way to compare percutaneous with surgical strategies for the treatment of carotid stenosis. These include the evaluation of emboli protection devices, and, to a lesser degree, intravenous glycoprotein IIb/IIIa antagonists. Other clinical trials are aimed towards refining the ability to stratify patients by risk, in order to identify the subsets that would benefit most from these complex and expensive procedures.

本综述对颈动脉介入技术与器械的最新进展进行了系统性概述，涵盖新型支架及栓塞保护装置（emboli protection devices）。新型自膨式支架（self-expanding stents）可减轻球囊扩张式支架（balloon expandable stents）易引发的支架外压迫问题，但支架精准释放以及支架与病变长度匹配的难题仍有待解决。本综述同时探讨了卒中（stroke）脑保护领域的新兴药物治疗方案。目前多项随机对照临床试验及多中心注册研究正有序开展，旨在对比经皮介入与外科手术治疗颈动脉狭窄（carotid stenosis）的临床策略效果，此类研究包括对栓塞保护装置的评估，以及在较小程度上对静脉用糖蛋白IIb/IIIa拮抗剂（glycoprotein IIb/IIIa antagonists）的相关研究。其余临床试验则致力于优化基于风险分层筛选患者的能力，以精准识别出可从这类复杂且高昂的手术中获益最多的患者亚群。