While coronary angioplasty (PTCA) with stenting revolutionized the treatment of coronary artery disease (CAD) and quickly gained widespread adoption, replacing coronary artery bypass graft (CABG) surgery for many patients, carotid angioplasty with stenting remains in its infancy. Twenty years after angioplasty revolutionized coronary revascularization, physicians generally prefer to stick with the surgical gold standard for carotid artery disease, carotid endarterectomy (CEA)—a traumatic but generally successful surgical procedure. That could begin to change, however, with the announcement, at this year's American Heart Association (AHA) meeting held in Chicago in November, of successful preliminary results from the SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy) clinical trial.
Driving this shift from surgery to carotid angioplasty is the successful development of embolic protection devices that diminish the likelihood that thrombus or emboli dislodged during stenting will move upstream to the brain creating the risk of stroke. That risk has discouraged many physicians from using percutaneous approaches to treat the arteries that vascularize the brain. While coronary angioplasty and stenting of native vessels carries a lower risk of complications, treating saphenous vein grafts (SVGs) and acute myocardial infarctions (AMIs) present significant challenges