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Sep04
WITH EMERGING TRENDS AND A SCIENCE THAT KEEPS REINVENTING ITSELF ITS NO SURPRISE TO COME ACROSS DIFFERENT TREATMENT MODALITIES EVEN ON A ROUTINE BASIS.PROBABLY NO OTHER SUBJECT IN VASCULAR SURGERY HAS RECEIVED SO MUCH ATTENTION AS IS THE TREATMENT OF CAROTID ARTERY DISEASES.WE HUMANS ARE PRONE TO GET HOOKED INSTANTANEOUSLY TO THINGS THAT ARE TERMED" NEW ARRIVALS" IN THE MARKET.FIRST RESULTS OF EVA-3S STUDY ARE ALREADY OUT AND THE GAME IS LOST BY THE STENTS AS THIS STUDY CLEARLY STATES THAT THE STROKE AND DEATH IN SYMTOMATIC CAROTID STENOSIS POPULATION WERE LOWER WITH ENDARTRECTOMY THAN WITH STENTING AT 1 AND 6 MONTHS.THE NON INVASIVE CHARACTER OF THE STENTING IS USED AS THE PRIMARY ARGUEMENT AGAINST OPERATIVE TREATMENT.ADDED TO THIS PROBABLY IS THE HUMAN INCLINATION TO AVOID SURGICAL PROCEDURES FOR INNATE FEAR OF KNIFE AND STUFF.
CONTRAINDICATIONS TO CAROTID ARTERY STENTING ARE IN PLENTY WHICH UNFORTUNATELY MOST OF OUR MEDICAL FRATERNITY IS UNAWARE OF OR ELSE PRETENDS TO .I FEEL AT THE END OF THE DAY ITS THE PATIENT WHO SHOULD BE THE FINAL BENEFICIARY AND EVERYTHING ELSE IS SECONDARY.
CAROTID ENDARTRECTOMY(CEA)IS A SAFE 60 MINUTES SURGICAL PROCEDURE DONE ON A ROUTINE BASIS WORLDWIDE WITH GRATIFYING RESULTS .THE PATIENT IS USUALLY DISCHARGED FROM THE HOSPITAL IN A DAY OR TWO POST PROCEDURE.IF AT ALL ECONOMY HAS SOME ROLE TO PLAY ,ITS JUSTIFIED TO SAY THAT IN A COUNTRY LIKE INDIA CAROTID ENDARTRECTOMY IS A FAR CHEAPER OPTION THAN STENTING EVEN AFTER TAKING INTO ACCOUNT THE SAFETY OF BOTH THE PROCEDURES.
I AM STATING FEW CONTRAINDICATIONS TO CAROTID STENTING THAT HAVE EVOLVED OVER A PERIOD OF TIME AND HAVE BEEN PUBLISHED IN VARIOUS VASCULAR SURGERY BOOKS AND VASCULAR SURGERY JOURNALS.
1)HEAVILY CALCIFIED PLAQUE
2)SOFT PLAQUE
3)DIFFULELY DISEASED CAROTID VESSELS
4)SEVERELY TORTUOUS AND ATHEROMATOUS AORTIC ARCH AND ITS BRANCHES
5)TORTUOUS CAROTID VESSELS
6)STRING SIGN
7)FREE FLOATING AND PEDUNCULATED THROMBUS
9)RECENT STROKE
10)SEVERE RENAL IMPAIRMENT PRECLUDING SAVE USE OF CONTRASTS
11)PRESENCE OF CONTRAINDICATIONS TO ANTIPLATELET AGENTS
12)INTERNAL CAROTID ARTERY SIZE LESS THAN 3 MM.

NOTE:ITS NOT EASY TO REPLACE A PROCEDURE LABELLED TO BE A "GOLD STANDARD".CAROTID ARTERY ENDARTRECTOMY(CEA)IS STILL THE GOLD STANDARD .PROBABLY IN HIGHLY SELECTED CASES CAROTID STENTING DOES HAVE A ROLE TO PLAY LIKE REDO SURGERIES OF THE CAROTID VESSELS, UNFAVORABLE ANATOMY LIKE VERY HIGH CAROTID BIFURCATION & RADIATION ARTERITIS.


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