[Angioplasty and stenting in patients with carotid artery stenosis]

Colaci C, Ciapponi A, Alfie V, Navarro E, Perelli L, García Marti S, Augustovski F, Pichon Riviere A, Alcaraz A
Record ID 32018004968
Original Title: Angioplastía con colocación de stent en pacientes con estenosis carotídea
Authors' recommendations: "Moderate-quality evidence shows that in patients with carotid artery stenosis both symptomatic, with stenosis greater or equal to 50%, and asymptomatic, with stenosis greater or equal to 60%, angioplasty with stenting has a negative effect due to a higher risk of experiencing a new stroke or death within 30 days after the procedure when compared with carotid endarterectomy. However, at long term, when comparing angioplasty and stenting with endarterectomy, no differences were observed between both groups of patients. In the case of symptomatic patients, in the subgroup of patients over 70, with a stenosis greater or equal to 50%, within 30 days after the procedures, angioplasty did not show benefit when compared with endarterectomy. Despite this, angioplasty is associated to a lower risk of experiencing myocardial infarction, cranial nerve palsy, restenosis, when compared with carotid endarterectomy, both in symptomatic and asymptomatic patients. Most clinical practice guidelines consulted include carotid angioplasty as an alternative treatment to endarterectomy, limiting its use for those patients with symptomatic carotid artery stenosis greater than 50% or asymptomatic patients with stenosis greater than 60%, with high surgical risk due to comorbidities and anatomical risk factors. The coverage policies consulted both international and regional, only consider the use of angioplasty in patients with symptomatic carotid artery stenosis or asymptomatic patients, if they show risk for surgery. In Argentina, the use of angioplasty and stenting for the treatment of carotid artery conditions is not covered by the Mandatory Medical Plan or cannot be recovered through the Unique Reimbursement System. The economic evaluations consulted have shown that endarterectomy is cost-effective when compared with angioplasty. No cost-effectiveness studies conducted in Argentina have been found".
Project Status: Completed
Year Published: 2023
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Argentina
MeSH Terms
  • Carotid Stenosis
  • Angioplasty
  • Stents
  • Endarterectomy, Carotid
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: <p>Institute for Clinical Effectiveness and Health Policy (IECS)</p>
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