Ruolo dell'ecografia nella valutazione della placca per l'indicazione allo stenting carotideo

Importance of Carotid Plaque characterization before Carotid Angioplasty and Stenting: the ICAROS study The procedure of endovascular angioplasty and stenting (CAS), from his introduction by Kerber, in 1980, after a long period of heated diatribes on the risk / benefit offered by it, but above all of extraordinary technological improvements, is now showing a valid therapeutic alternative to the traditional surgical carotid endarterectomy (CEA), in the treatment of prevention of cerebral ischaemia. The preliminary results of the Sapphire study, which randomized patients at high surgical risk, showed that in this particular group there is an advantage of CAS performed with cerebral protection, the incidence of peri-procedural major events (death, stroke or myocardial infarction) is 5.8% compared to 12.6% of the CEA. Apart from the technical expertise, particularly relevant in endovascular techniques, and the anatomic contraindications to CAS - vessels access eccessivametne stenotic or tortuous, the angle of the arch or the supra-aortic arteries and sub-occlusive stenoses - the literature increasingly shows the importance of carotid plaque morphology. Its careful assessment is now indispensable for a correct indication to angioplasty and stenting, in order to obtain the best therapeutic results.