Carotid Artery Stenting for High-risk Patients(2. Atherosclerotic Internal Carotid Artery Disease and High Risk Patients,<SPECIAL ISSUES>Stroke as a Systemic Vascular Disease)

Abstract

Carotid artery stenting (CAS) is indicated even for high-risk carotid endarterectomy patients. However, CAS carries its own high-risk and difficulties due to access route problems such as atherosclerosis, tortuousity, nearly total occlusion and aneurysms, as well as those posed by lesion characteristics such as circled calcification, dangerous plaque, and floating thrombus. The added complications of elderly patients, hypercoagulopathy and intimal fragility due to diabetes mellitus are troublesome in both treatment options. Particularly, cholesterol crystal embolization is a rare but fetal ischemic complication. Patients with severe coronary ischemic disease should be carefully managed for postoperative hypotension. General risk management based on the preoperative evaluation of each patient's general condition, access route, lesion, plaque, collateral pathway and cerebral blood flow and the operator's technical capabilities, as determined by national qualification system rating, is mandatory for the treatment of such high-risk patients. Anti-platelet therapy and certain protection methods are particularly important to avoid ischemic complications. It is also important to take measures for an adequate treatment strategy, to have high quality skill and to be capable of rapid trouble shooting for any unexpected accidents.