Future Directions Angioplasty and Stenting

Angioplasty and stent placement have gained some popularity for the treatment of atherosclerosis, dissection and other conditions leading to stenosis of the cerebral vasculature. It has become clear to most clinicians that angioplasty alone of cervical or cerebral arteries has a high complication and re-stenosis rate and, thus, has become much less frequently utilized. Advances in stent technology have resulted in more effective treatment methods for intracranial and extracranial lesions. Recently, angioplasty stenting of the carotid arteries has been advocated to treat internal carotid artery stenosis. There is a subgroup of patients with significant medical co-morbidities and high neurologic risk that might qualify for carotid angioplasty and stenting procedures. Several reports have indicated that high-risk patients and patients who meet strict criteria might benefit from stenting, with a minimum of morbidity and mortality [37,38].

Prospective randomized trials have begun to try to determine if angioplasty and stent placement in the internal carotid artery can be performed with equal or improved safety and efficacy as carotid endarterectomy in equivalent groups of patients; however, results have not been encouraging.

A trial in the UK was stopped due to the high stroke rate in the endovascular group.

Twenty-three patients with focal carotid territory symptoms and severe ICA stenosis (more than 70%) were randomized to either CEA or endovascular stenting [39]. CEA with patching or stenting were used as interventions. The main outcome measures were death or disabling or non-disabling stroke within 30 days. All ten CEA operations proceeded without complication, but five of the seven patients who underwent CA had a stroke (P = 0.0034). Results of the CAVATAS trial comparing endovascular treatment with conventional carotid surgery have also been reported. This trial assigned 504 patients with carotid stenosis to endovascular treatment (n = 251) or carotid endarterectomy (n = 253). The rates of major outcome events within 30 days of first treatment did not differ significantly between endovascular treatment and surgery (6.4 vs 5.9%, respectively, for disabling stroke or death; 10.0 vs 9.9% for any stroke lasting more than 7 days, or death). The stroke rate in both groups, however, was higher than previously reported results for endarterec-tomy and thus were associated with a diminished effect on stroke prevention in these groups of patients.

Newer endovascular devices are now being evaluated which prevent distal embolization associated endovascular treatment. It is believed that distal embolization is one of the major factors associated with stroke in patents undergoing stent procedures. Future trials will no doubt be conducted using these devices. Currently carotid endarterectomy remains the procedure of choice in otherwise uncomplicated patients with carotid stenosis who meet the criteria for treatment.

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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