Ep. 631 Advancements in Carotid Stenting with Dr. Adnan Siddiqui

·37 min·3 clips

Dr. Adnan Siddiqui reveals that new carotid stents have under 1% risk for stroke, heart attack, and death.

The episode features Dr. Adnan Siddiqui, a neurosurgeon and researcher, discussing carotid artery stenting advancements. He begins by noting that second-generation stents like InspireMD and NeuroGuard have risk profiles under 1% for stroke, MI, and death. Dr. Siddiqui provides a historical overview, explaining that carotid disease was initially treated with aspirin until vascular surgeons developed endarterectomy in the 1960s, proven effective in trials like ACAS and ACST. He describes the shift to stenting in the 1990s, using biliary stents initially, with trials like SAFIRE showing stenting was better for high-risk patients. Dr. Siddiqui highlights the CREST-2 trial results, which demonstrated that carotid angioplasty and stenting is better than best medical therapy, a key milestone. He discusses recent CMS coverage changes allowing reimbursement for stenting in symptomatic 50% or asymptomatic 70% stenosis. Dr. Siddiqui outlines his patient selection criteria, treating asymptomatic disease only if patients have a five-year life expectancy. He compares new stent technologies: RoadSaver with dual-layer mesh, NeuroGuard for faster procedures, and InspireMD for plaque protection. Dr. Siddiqui offers five tips for new operators, including training at high-volume centers, focusing on aortic catheterization, using proximal and distal protection, starting with easy cases, and following an algorithm based on arch and lesion characteristics. He emphasizes the importance of proctoring and tele-proctoring for safety. Dr. Siddiqui predicts that 90% of carotid revascularization will be endovascular in the future and expresses excitement about IVL technology to reduce post-procedural hypotension. He concludes with advice on managing complications, such as having access to specialists and understanding neuroangiography.

As heard by us

A high-volume carotid practice links evolving stent technology to practical decisions about technique and case selection.

Carotid stenting is framed here as both a device story and a procedural one, with attention on improved stents, embolic protection, and the choices that shape a case.

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Why you'd press play

You want to know how NeuroGuard can turn a five- or six-minute carotid filter window into about one.

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