An Industry Perspective on the Carotid Space
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Abbott Vascular
On Monday’s ISET 2025 session on carotid therapy, Ethan Korngold, MD, chief medical officer at Abbott Vascular, provided an industry perspective on the evolving role of carotid artery stenting (CAS) in stroke prevention. The session covered historical and recent clinical trials, advances in stent technology, patient selection criteria, and the role of multidisciplinary collaboration in optimizing patient outcomes.
Dr Korngold first discussed how stroke remains the second leading cause of death globally and a major cause of long-term disability, and that coronary artery disease is a significant contributor to ischemic stroke, necessitating effective treatment strategies. Historically, carotid endarterectomy (CEA) was the standard of care, but CAS has achieved parity with CEA in select patient populations.
Reviewing the clinical evidence supporting CAS, Dr Korngold mentioned the CREST-1 trial, which showed CAS was non-inferior to CEA for long-term stroke prevention, with similar rates of periprocedural complications; and the ACT I trial, which demonstrated that CAS was comparable to CEA in low-risk asymptomatic patients. The 10-year CREST data confirmed CAS outcomes were durable, with no significant difference in mortality between CAS and CEA.
The key risk factors were then discussed, including periprocedural stroke and myocardial infarction (MI), which remain key risks associated with CAS. The refinement of patient selection criteria—using advanced imaging such as computed tomography angiography and magnetic resonance angiography—has significantly reduced complications.
Emerging technologies in CAS came next, with Dr Korngold indicating that recent meta-analyses suggest similar outcomes between transradial and transfemoral approaches. New devices such as the Walrus™ balloon guide catheter have demonstrated high technical success and low periprocedural stroke rates, and innovative dual-layer stent designs are designed to improve embolic protection and reduce in-stent restenosis.
Dr Korngold then discussed transcarotid artery revascularization (TCAR), which is gaining traction as an alternative to traditional CAS, particularly for patients with difficult arch anatomy or high surgical risk. The Centers for Medicare & Medicaid Services has expanded coverage for TCAR, leading to increased adoption, and non-randomized data from the Vascular Quality Initiative (VQI) indicate TCAR has comparable stroke and mortality rates to CEA, making it a viable option for select patients.
In conclusion, CAS has evolved into a viable alternative to CEA for stroke prevention, with comparable long-term outcomes, and Dr Korngold emphasized the importance of a multidisciplinary "Heart-Brain" team approach to optimize treatment decisions, procedural success, and patient outcomes.
