Carotid Interventions

Dr. Ankur Aggarwal is a vascular surgeon practicing at Franciscan Health in Indianapolis, Indiana. He discusses options for treating asymptomatic and symptomatic patients with carotid lesions, as well as patient education over open vs. closed interventions. Dr. Aggarwal also underscores the importance of optimizing medical management, as this can reduce the progression of the carotid stenosis and promote more favorable post-intervention outcomes.

Dr. Aggarwal highlights how patient age is a major factor to consider when deciding between open endarterectomy, transfemoral carotid stenting, or transcarotid artery revascularization (TCAR). He also compares indications, contraindications, and risk of complications, and follow up for each procedure.

Then, the doctors debate TCAR vs. transfemoral carotid artery stenting. They review the clinical data, anatomical criteria, ongoing clinical trials, and device evolution of each procedure. Dr. Aggarwal highlights shifting practices, with more and more surgeons performing TCAR. Per Dr. Aggarwal, the learning curve for TCAR is also much easier than other treatment modalities. Stent sizing, bailouts, and fallback to open vascular surgery in the event of major complications are also discussed.

To conclude the episode, Dr. Aggarwal discusses carotid stroke and nerve injury risks in open endarterectomy, TCAR, and transfemoral carotid stenting. Dr. Aggarwal states that acute carotid emergencies are best treated by neurointerventional surgeons rather than vascular surgeons. Vascular surgery can be considered if any chronic issues remain two days to two weeks after the neurointerventionalist has addressed the primary problem.