Emerging treatments
Carotid stenosis risk prediction tool
There are several tools available that can be used to predict the risk of stroke in patients and stratify patients for specific therapies; however, none of them are prospectively validated or recommended by guidelines. One example is the carotid stenosis risk prediction tool. It is a model used for predicting the risk of ipsilateral ischemic stroke in patients with recently symptomatic carotid bifurcation stenosis. This tool is currently considered to be a research tool. Carotid stenosis risk prediction tool Opens in new window A recalibrated version of this tool (the Carotid Artery Risk Score) is being tested in European Carotid Surgery Trial 2. European Carotid Surgery Trial 2 (ECST-2) Opens in new window
Transcarotid artery revascularization
Transcarotid artery revascularization (TCAR) is a hybrid approach to treat carotid artery stenosis. The procedure requires surgical access to the common carotid artery at the base of the neck through an incision just above the clavicle, the introduction of a novel cerebrovascular flow-reversal device, and direct stenting of the carotid artery lesion. The flow-reversal device and accompanying carotid stent received Food and Drug Administration (FDA) approval in the US in 2015. Surgeons within the US have received standardized training in this procedure.[46] The learning curve for this form of carotid artery stenting is quite steep.[47] The stroke and death rates with TCAR are low in observational studies and in nonrandomized comparisons with transfemoral carotid artery stenting or carotid endarterectomy.[48][49][50] While these results are encouraging, the exact role of TCAR in carotid artery revascularization remains to be clarified since there is no planned randomized trial comparing medical therapy to TCAR in asymptomatic patients, and no such trial planned comparing its performance to transfemoral carotid stenting or to carotid endarterectomy.
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