E1624. Different Strokes for Different Folks: Anatomical Considerations for Extracranial Atherosclerotic Carotid Disease Treatment
  1. William Forshee; University of Florida Health Jacksonville
  2. Mario Agrait-Bertran; University of Florida Health Jacksonville
  3. Grzegorz Brzezicki; University of Florida Health Jacksonville
  4. Joanna Kee-Sampson; University of Florida Health Jacksonville
When proceeding with treatment for extracranial atherosclerotic disease, it is important to consider the patient’s anatomy when determining whether carotid endarterectomy (CEA) or carotid artery stenting (CAS) is the most feasible. In this educational exhibit, we will review the anatomical considerations for CEA and CAS with a discussion of newer techniques such as transcarotid artery revascularization (TCAR).

Educational Goals / Teaching Points
This exhibit will be an overview of atherosclerotic disease of the cervical carotid arteries, which can be asymptomatic or symptomatic. We will review the advantages and disadvantages of the different carotid imaging modalities for atherosclerotic disease. Additionally, we will discuss anatomical considerations that are important factors to consider when deciding whether carotid endarterectomy (CEA) or carotid artery stenting (CAS) is the best method for each individual patient in the treatment of atherosclerotic disease.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will highlight the indications for imaging extracranial carotid disease in neurologically symptomatic and asymptomatic patients. Additionally, it will discuss the image selection in asymptomatic patients, low-risk symptomatic patients, and high-risk symptomatic patients. Subsequently, it will illustrate the imaging findings of atherosclerotic carotid disease on ultrasound (US), computed tomography angiography (CTA) [specifically, The North American Symptomatic Carotid Endarterctomy Trial (NASCET) criteria for grading stenosis], magnetic resonance imaging/magnetic resonance angiography (MRI/MRA), and catheter-based digital subtraction angiography. Next, it will cover the treatment of atherosclerotic carotid disease, specifically what anatomical considerations indicate CAS versus CEA. The following anatomic considerations help guide a collaborative team of physicians towards selection of CAS or CEA: aortic arch configuration, carotid tortuosity, aortoiliac disease, level of carotid bifurcation, “hostile” neck, length of lesion, and lesion calcification. Finally, this exhibit will discuss newer techniques, such as TCAR.

In brief, this educational exhibit will review imaging indications, image selection, the respective imaging findings for each modality, and the most appropriate treatment options for extracranial carotid disease based on patient symptoms and anatomical considerations.