Conversion to carotid artery stenting after neurological intolerance at cross-clamping during carotid endarterectomy: is it a safe option?

IF 1.4 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

International Angiology Pub Date : 2025-08-01 DOI:10.23736/S0392-9590.25.05453-7

Arkadiusz Migdalski, Arkadiusz Jawień

{"title":"Conversion to carotid artery stenting after neurological intolerance at cross-clamping during carotid endarterectomy: is it a safe option?","authors":"Arkadiusz Migdalski, Arkadiusz Jawień","doi":"10.23736/S0392-9590.25.05453-7","DOIUrl":null,"url":null,"abstract":"Introduction: In the case of intolerance to cross-clamping (CC) during carotid endarterectomy (CEA), the method-of-choice is to place a shunt and continue the procedure. However, some centers abandon open carotid revascularization in case of CC intolerance and perform conversion to carotid artery stenting (CAS). This approach remains controversial and is not accepted by many clinicians.Evidence acquisition: PubMed, Embase, Web of Science and Cochrane databases were searched for reports published over the last 15 years (2010-2025) regarding conversion to CAS after neurological intolerance to CC during CEA.Evidence synthesis: Carotid CC intolerance may develop in around 10% of patients undergoing CEA under locoregional anesthesia. There is some evidence that patients who develop CC intolerance may have higher degrees of contralateral carotid stenosis and a higher incidence of perioperative cerebrovascular events compared with individuals who do not develop neurological symptoms after CC. Conversion to CAS may be an alternative to usage of a shunt.Conclusions: The occurrence of carotid CC intolerance during CEA may be a reason to abandon the procedure and convert to CAS. Nonetheless, the evidence on this topic is not robust, as it is based on small, single-center studies. A multicenter study may provide better-quality evidence in the future.","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 4","pages":"311-315"},"PeriodicalIF":1.4000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Angiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.23736/S0392-9590.25.05453-7","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: In the case of intolerance to cross-clamping (CC) during carotid endarterectomy (CEA), the method-of-choice is to place a shunt and continue the procedure. However, some centers abandon open carotid revascularization in case of CC intolerance and perform conversion to carotid artery stenting (CAS). This approach remains controversial and is not accepted by many clinicians.

Evidence acquisition: PubMed, Embase, Web of Science and Cochrane databases were searched for reports published over the last 15 years (2010-2025) regarding conversion to CAS after neurological intolerance to CC during CEA.

Evidence synthesis: Carotid CC intolerance may develop in around 10% of patients undergoing CEA under locoregional anesthesia. There is some evidence that patients who develop CC intolerance may have higher degrees of contralateral carotid stenosis and a higher incidence of perioperative cerebrovascular events compared with individuals who do not develop neurological symptoms after CC. Conversion to CAS may be an alternative to usage of a shunt.

Conclusions: The occurrence of carotid CC intolerance during CEA may be a reason to abandon the procedure and convert to CAS. Nonetheless, the evidence on this topic is not robust, as it is based on small, single-center studies. A multicenter study may provide better-quality evidence in the future.

查看原文本刊更多论文

颈动脉内膜切除术中交叉夹持神经不耐受后转作颈动脉支架植入术：这是一个安全的选择吗？

在颈动脉内膜切除术（CEA）中，如果不耐受交叉夹持（CC），选择的方法是放置分流器并继续手术。然而，一些中心在CC不耐受的情况下放弃开放颈动脉重建术，转而进行颈动脉支架植入术（CAS）。这种方法仍有争议，不被许多临床医生接受。证据获取：检索PubMed， Embase， Web of Science和Cochrane数据库，检索过去15年（2010-2025年）发表的关于CEA期间CC神经不耐受后转化为CAS的报告。证据综合：约10%的CEA患者在局部麻醉下可发生颈动脉CC不耐受。有证据表明，与CC后未出现神经系统症状的患者相比，发生CC不耐受的患者可能有更高程度的对侧颈动脉狭窄和更高的围手术期脑血管事件发生率。转换为CAS可能是使用分流器的替代方案。结论：CEA期间颈动脉CC不耐受的发生可能是放弃手术而改用CAS的原因。然而，关于这个话题的证据并不可靠，因为它是基于小的、单中心的研究。多中心研究可能在未来提供更高质量的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

International Angiology 医学-外周血管病

CiteScore

2.80

自引率

28.60%

发文量

审稿时长

6-12 weeks

期刊介绍： International Angiology publishes scientific papers on angiology. Manuscripts may be submitted in the form of editorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work. Duties and responsibilities of all the subjects involved in the editorial process are summarized at Publication ethics. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (ICMJE).