PERSPECTIVES FOR CAROTID ANGIOPLASTY

Advantages and risks: Widely advocated as reliable and cost-effective, carotid angioplasty offers many advantages. Theoretically, general an esthesia can be avoided and no incision is required, authorizing its i ndication in patients with a contraindication for conventional open su rgery although the risks of vascular complications-emboli, dissection, acute thrombosis-and general complications must not be underestimated . Need for valid assessment: Few studies evaluating this new technique have been published. Among the open trials including over 100 patient s, indications have generally been limited to patients with a high sur gical risk and combined morbidity and mortality has been reported to v ary from 2.8% to 9.6%. No rigorously controlled comparison with conven tional surgery has been published although several projects are curren tly under way or in the planning stages (CAST in Europe and CASET and CREST in North America). Lessons from the current situation: Carotid a ngioplasty requires a highly equipped facility and a multidisiplinary team with competence in catheterism and micro-catheterism, thombolysis , and stenting techniques. Technical advances in material engineering are also needed to provide flexible, stable and modulable stents. Desp ite the still imprecise nature of the current situation, one can predi ct that these techniques will come to be complementary, ii not competi tive, alternatives to conventional carotid surgery.