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(Circulation. 1998;98:927-930.)
© 1998 American Heart Association, Inc.

Current Perspective

Stent-Supported Carotid Angioplasty

Should It Be Done, and, If So, by Whom? A 1998 Perspective

Gerald Dorros, MD

From the Arizona Heart Institute Foundation, Phoenix.

Key Words: carotid angioplasty • stents • carotid endarterectomy

Cardiologists, focusing primarily on the heart and its function, diseases, and treatments, had until recently expressed minimal interest in peripheral vascular diseases. Now, spurred on by their successful endovascular treatments of a variety of cardiac pathologies, a few cardiologists have championed the proposal that endovascular treatments should be disease specific and not site specific; thus, their interventional efforts should not be limited to the heart. This perspective has been perceived by some medical and surgical specialties as self-serving and demeaning of these specialties and their accomplishments. In addition, the structure of cardiology training programs has paid little or no attention to the natural history, pathology, diagnosis, and management of vascular patients, let alone endovascular therapeutic procedures. In addition, many peripheral endovascular publications, written in large part about observational studies by private practice cardiologists, have been viewed with circumspection by others, because the authors focused on clinical issues outside their area of expertise, and their audacity transcended the sacrosanct, but nebulous, specialty boundaries. Although these arenas were often considered to be outside the purview of cardiologists, the results of these investigations motivated other cardiologists to move forward. Now, the efforts of cardiologists to vanguard the evaluation of endovascular revascularization techniques involving obliterative extracranial carotid bifurcation disease have made more transparent the significant interdisciplinary tensions that were created, in part, not only by physicians' angst about their future but also by the blurring of the distinctions between specialties.

A few cardiologists have made these more taut through their premature conclusions and extrapolations . . . [Full Text of this Article]

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