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RobertM.Bersin,MDFACCFSCAIRobertM.Bersin,MDFACCFSCAIDirector,EndovascularServicesandClinicalResearchDirector,EndovascularServicesandClinicalResearchSeattleCardiologySeattleCardiologyCardiovascularConsultantsofWashingtonCardiovascularConsultantsofWashingtonSeattle,WashingtonSeattle,WashingtonCardiovascularConsultantsofWashingtonCardiovascularConsultantsofWashingtonCarotidCarotidStentingStentingEquipmentEquipmentandTechniqueandTechniqueRMBersinSCAICoreCurriculuminCarotidStenting2006DisclosureInformationTechniqueofCarotidTechniqueofCarotidStentingStentingRobertM.BersinMD,FSCAIRobertM.BersinMD,FSCAIThefollowingrelationshipsexistrelatedtothispresentation:NameofCompany:BostonScientificAB,C,GS,P,SBNameofCompany:Bristol-MyersSquibbC,SBNameofCompany:CordisEndovascularAB,C,EI,P,SB,SENameofCompany:E.ILillyC,SBNameofCompany:ev3PNameofCompany:GuidantCorporationC,PNameofCompany:TheMedicinesCompanySBNameofCompany:Sanofi-AventisC,SBNameofCompany:VascularArchitectsSONameofCompany:VascularSolutionsAB,C,SOOfflabeluseofproductswillbediscussedinthispresentation:investigationalcarotidstentsystemsAB:AdvisoryBoardC:ConsultingRelationshipEI:EquityInterestGS:GrantSupportP:ProctororTrainingCourseSponsorshipsSB:SpeakersBureauSE:SpouseEmployeeSO:StockOptionsorPositionsRMBersinSCAICoreCurriculuminCarotidStenting2006CarotidStentTrialMedicationsNAAsneededforthrombus,WarfarinRx70U/KgACT250-300secNAHeparinNotrecommended250mgBIDtwoweeks250mgBID250mgBIDTiclopidineNotrequired75mgtwotofourweeks300-450mg4hrsprior75mgClopidogrel81-325mgindefinitely81-650mg81-650mg81-650mgAspirinPost-Procedure>30daysPost-Procedure�30daysDayofProcedurePre-Procedure2-3daysMedicationACTI,ACTI,ARCHeRARCHeR,BEACH,CABERNET,CREATE,CREST,,BEACH,CABERNET,CREATE,CREST,MAVERiCKMAVERiCK,SAPPHIRE,,SAPPHIRE,SECuRITYSECuRITYFatalCarotidStentThrombosisLackofCombinationLackofCombinationAntiplateletAntiplateletTherapyTherapyIntraproceduralIntraproceduralASAOnlyASAOnly72HrsPost-Stent72HrsPost-StentNoNoAntiplateletAntiplateletChaturvediSetalStroke2001;32:2700-02RMBersinSCAICoreCurriculuminCarotidStenting2005RMBersinSCAICoreCurriculuminCarotidStenting200630-DayTotalStrokeinU.S.CarotidStentingHighRiskRegistries3.44.04.24.55.65.86.90246810Patients(%)Patients(%)ARCHeR2ARCHeR2(ACC2003)(ACC2003)SAPPHIRESAPPHIRE(AHA2002)(AHA2002)SECuRITYSECuRITY(TCT2003)(TCT2003)BEACHBEACH(TCT2004)(TCT2004)MAVErICMAVErIC(TCT2004)(TCT2004)CREATECREATE(TCT2004)(TCT2004)CABERNETCABERNET(TCT2004)(TCT2004)RMBersinSCAICoreCurriculuminCarotidStenting2006EVA-3STrialEVA-3STrialMasJLetal.NEnglJMed2006;355:1660-1671DualAnti-plateletuse82.9%DualAnti-plateletuse82.9%SymptomaticCarotidSymptomaticCarotidStenosisStenosisRMBersinSCAICoreCurriculuminCarotidStenting2006GuideCatheterTechniqueGuideCatheterTechniqueRMBersinSCAICoreCurriculuminCarotidStenting2006InitialAccessInitialAccess�Strokerisk�Placingguidecatheter�Telescope5frVTK125cmcatheterthrough100cmguidecatheter(Headhunter,HockeyStick,JR4,etc.)�EngagecarotidwithVTK�SlideguideoverVTKandintocarotidRMBersinSCAICoreCurriculuminCarotidStenting2006CarotidGuidingCathetersCarotidGuidingCathetersRMBersinSCAICoreCurriculuminCarotidStenting2006GuideAlternativesGuideAlternatives�Additionalsupport:�Steerable0.035”wire(Storq,MagicTorque,SupraCore,etc)or0.014buddywire�ForsmallCCAorostialplaque:sheathtechniqueRMBersinSCAICoreCurriculumin...