Endoarteriectomia od Angioplastica Carotidea? Utilità della Valutazione Computerizzata Ecografica della Placca

Carotid Endarterectomy or Angioplasty? Usefulness of the computerized echographic characterization of the carotid plaque Carotid Angioplasty and Stenting (CAS) is being increasingly performed, apart from Carotid Endarterectomy (CEA), for the treatment of bifurcation atherosclerotic lesions. Indications to CEA have been established by International Randomized Trials versus medical treatment (NASCET, ECST, ACS, etc.), while indications to CAS will be defined following the results of randomized prospective trials versus CEA (CREST, etc.), only after a long follow up. The outcome after CAS has been improved by the refinements in technology, stents and cerebral protection by means of filters or occlusion balloons. Besides high surgical risk for general conditions (severe cardio-pneumopathy), or local conditions (restenosis, post-radiation, post-radical neck dissection), indication to Angioplasty and Stenting must consider the morphology of the carotid plaque. A ready available computer software allows evaluation of the echogenicity of the plaque, minimizing operator, device and patients’ variability. With the use of this computerized method we started a Registry of CAS named “ICAROS”, which, collecting experiences from many centers, should be able to define the echographic characteristics of the carotid plaque for surgical or endovascular treatment.