Improving Carotid Revascularization Outcomes Through Collaboration
This has been an interesting year in the management of severe bifurcation stenosis. Although there have been no new randomized data to reflect on, carotid revascularization continues to be a subject of much discussion, and sometimes, disagreement.
The Society for Vascular Surgery, cosigner of a multisociety document published in early 2011, also issued its own, at times contradictory, guidelines statement. This not only confused the guidance for practitioners but also abrogated their responsibility to the guidelines process.
A MEDCAC panel was convened in January, which created a lot of heat, but unfortunately, shed very little light on the subject. This was largely the result of an imbalance in the specialty constituency of the panel, as well as a series of questions that were unclear in their intent, making it difficult for the panel to address them definitively.
As of yet, there is no change in the CMS coverage policy for CAS, and the number of available and covered postmarket surveillance registries has been reduced as these registries wrap-up their enrollment. Despite FDA approval for the entire range of patient types—symptomatic and asymptomatic, high and standard surgical risk—the net effect is less access to CAS in the US than at any other time in the past 5 years.
In response, we offer this annual edition of Endovascular Today and have assembled an excellent series of articles. Willem Willaert, MD, PhD, and Isabelle Van Herzeele, MD, PhD, discuss the approaches to standardizing outcomes for CAS. Dr. Macdonald details the ongoing improvements in CAS technology, which is hoped to not only further reduce the event rates in CAS but also lead to an increased acceptance of CAS in general. Joshua A. Beckman, MD, and Dr. Gray look at the current controversies in the treatment of asymptomatic patients, and Takao Ohki, MD, PhD, offers his Tokyo-based Jikei University CEA technique that is intended to promote improvements in CEA outcomes.
There are several important trials that are currently ongoing or being planned, which will contribute meaningfully to our understanding and the management of carotid artery disease. We are privileged to have the principal investigators of the ACST-2 and ECST-2 studies share updates on the status of these trials.
We would also like to share an interesting Techniques article by Michael J. Pompliano, BS, and George L. Adams, MD, MHS, who describe a transcollateral approach for revascularization of chronic total occlusions in the superficial femoral artery. We also have a Challenging Cases article from Jose A. Echeverri, MD; Gregory L. Horsley, MD; Lawrence D. Buadu, MD, PhD; and John Buterbaugh, MD, which details percutaneous recanalization of an inferior vena cava that was previously surgically ligated.
This month, we asked Desmond Bell, DPM, CWS, to talk with us about peripheral arterial disease awareness and efforts we can make, through organizations such as Save a Leg, Save a Life, to improve care for these patients.
We have enjoyed putting together this edition of Endovascular Today and would like to thank all of our contributing authors.