Carotid and Innominate Artery Stenting for High-Risk Patients

Carotid artery stenting with embolic protection (CAS) is a safe and effective alternative to carotid endarterectomy (CEA) for symptomatic carotid stenosis and in asymptomatic patients with critical stenotic lesions. Radiation arteritis has recently been defined as a unique pathophysiological process distinct from atherosclerosis. Much of the morbidity and mortality associated with CEA is secondary to the risk of cardiac events in the perioperative period. Defining who is a high-risk patient for adverse cardiac events after endarterectomy continues to be investigated. Isolated innominate artery disease is a rare form of vascular pathology. Patients with innominate artery stenosis have a range of clinical presentations, and many patients remain completely asymptomatic, with their lesions diagnosed incidentally. Endovascular intervention has now been established as first-line therapy for patients with innominate artery stenosis. Brachial artery approaches are typically performed via cut-down to avoid any complications arising from brachial sheath hematomas.