Carotid artery stenting

Treatment options for carotid artery stenosis include medical therapy, surgery to remove the atherosclerotic plaques (carotid endarterectomy or CEA), and the percutaneous placement of stents (CAS) in the affected area. During CAS, the clinician threads a catheter through an artery up from the groin and up to the carotid artery. The catheter has an attached balloon which expands the artery and inserts a stent to hold the artery open. Multiple stents may be placed depending on lesion length. Because there is a risk of disrupting the plaque along the artery walls during this type of procedure, CAS is usually performed along with a filter, or distal embolic protection device (EPD) which is used to capture any debris that becomes dislodged, reducing the risk of embolization.

Status: Decision completed

Why is CAS being reviewed?

The topic was nominated based on high levels of concern around efficacy and cost, and on medium levels of concern around safety.

Primary criteria ranking

  • Safety = High
  • Efficacy = High
  • Cost = Medium

Documentation

Assessment timeline

  • Draft key questions published: November 26, 2012
  • Public comment period: November 26 to December 11, 2012
  • Draft report published: June 28, 2013
  • Public comment period: June 28 to July 30, 2013
  • Final report published: August 15, 2013
  • HTCC public meeting: September 20, 2013