HOLLYWOOD, Fla. — Several new technologies are available or on the horizon to improve the outcomes of carotid artery stenting, according to a speaker at the International Symposium on Endovascular Therapy (ISET).
“There has been some suppression of carotid activity in the [United States] largely based on reimbursement limitations. This has been challenging but, despite that, there has been a plethora of new technologies for carotid stenting which are meant to address some pivotal opportunities,” William A. Gray, MD, system chief of the division of cardiovascular disease at Main Line Health and president of the Lankenau Heart Institute in Wynnewood, Pennsylvania, said during a presentation.
Next, there is direct carotid access with high flow reversal with transcarotid artery revascularization (TCAR) using the Enroute device (Silk Road Medical). This technology allows for a small surgical incision above the clavicle for direct carotid access and initiation of high flow reversal into a venous circuit with a filter to protect the brain from stroke while delivering and implanting the Enroute Transcarotid Stent. Data from the ROADSTER trial showed a very low rate of stroke, including in high-risk subgroups who are symptomatic and aged older than 75 years. Additionally, TCAR showed fewer diffusion-weighted imaging abnormalities after the procedure and comparable to CEA, which Gray said demonstrates mechanistic proof of improved embolic protection.
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