[Angioplasty with stent placement in patients with carotid artery disease]

Alfie V, Alcaraz A, Pichon-Riviere A, Augustovski F, García Martí S, Bardach A, García Martí S, Ciapponi A.
Record ID 32018001564
Original Title: Angioplastía con colocación de stent en pacientes con patología carotídea
Authors' recommendations: High-quality evidence suggests that in patients with asymptomatic carotid artery stenosis equal or greater than 70%, angioplasty with stent placement versus carotid artery endarterectomy shows similar efficacy in terms of the risk of experiencing a new ipsilateral stroke or death due to stroke at long term in both groups of patients. However, the risk of periprocedural stroke is higher in patients undergoing an angioplasty when compared with endarterectomy. In the case of symptomatic patients with a stenosis equal or greater than 50%, angioplasty presents similar efficacy at long term as to the risk of experiencing a new ipsilateral stroke when compared with endarterectomy. Angioplasty is associated to a higher risk of stroke within 30 days of performing the procedure versus endarterectomy in patients over 75 years old with a history of cardiovascular disease. However, angioplasty is related to a lower risk of presenting myocardial infarction, cranial nerve palsy or hematomas in the access site when compared with carotid artery endarterectomy, at short term. Low-quality evidence does not allow to determine the efficacy of angioplasty versus medical treatment in patients with symptomatic carotid artery stenosis and the contraindications for endarterectomy. As regards the use of angioplasty to treat pseudoaneurysm and carotid artery aneurysms, very low-quality evidence, coming from a small case series does not allow to draw conclusions on its efficacy for this indication. The clinical practice guidelines surveyed include carotid artery angioplasty as an alternative treatment to endarterectomy, restricting its use to those patients with symptomatic carotid artery stenosis greater than 50% or to asymptomatic patients with stenosis greater than 70%, who are not eligible for surgical treatment due to comorbidities and anatomical risk factors (patients who have previously received radiation in the neck or with carotid artery restenosis). The coverage policies consulted consider the use of angioplasty just for the indications mentioned in the clinical practice guideline. In Argentina, the use of angioplasty with stent placement for the treatment of carotid artery disease is not covered by the Mandatory Medical Program or cannot be recovered through the Unique Reimbursement System. The economic evaluations conducted in the United Kingdom and the United States did not show significant differences in costs and quality adjusted life years between both therapeutic strategies. No cost-effectiveness studies carried out in Argentina have been found.
Project Status: Completed
Year Published: 2020
URL for published report: https://www.iecs.org.ar/home-ets/
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Argentina
MeSH Terms
  • Carotid Stenosis
  • Angioplasty
  • Stents
  • Endarterectomy, Carotid
  • Carotid Artery Thrombosis
Organisation Name: Institute for Clinical Effectiveness and Health Policy
Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA
Contact Name: info@iecs.org.ar
Contact Email: info@iecs.org.ar
Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)
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