Not only is it safe but it is also effective

Editorial Comment

Not Only Is It Safe But It Is AlsoEffective

David R. Holmes, Jr., MD

Mayo Clinic,Consultant in Cardiovascular DiseasesScripps Profess in Cardiovascular MedicineProfessor of Medicine,Mayo Clinic College of MedinineRochester, Minnesota 55905

The continued evolution of new technologicalapproaches and strategies of care has revolutionizedmodern cardiovascular disease. This process representsthe opportunity to significantly change and hopefullyimprove patient care and outcome. This process alsobrings with it major challenges for health care systems;these challenges include issues of training and creden-tialing as well as certification. This is particularly im-portant and can be particularly problematic when mul-tiple different specialties are involved.

The whole field of the application of techniques ini-tially used to treat coronary artery disease by interven-tional cardiologists to now the treatment of othervascular beds such as carotid artery disease is verygermane to the above issues. In this setting we have:(1) new adaptation of technologies that have beenwidely used in interventional cardiology, (2) a differentvascular bed to be treated, (3) the potential for verydifferent complication patterns than interventional car-diologists have ever been used to, (4) an already wellestablished procedure—surgical carotid endarterectomy,

and (5) multiple specialties involved including neuroand vascular surgery, radiology, and now interventionalcardiology. To this field, interventional cardiologybrings unique skills and knowledge which can be usedto improve outcome.The Society of Cardiac Angiography and Interven-

tions (SCAI) has been a leader in developing compe-tence standards on carotid stenting as well a leader indeveloping simulation models for training and certifica-tion. More recently, SCAI has been involved in furtherexpanding that in the development of the concept ofstroke centers.A piece that has been missing in the past is transla-

tion of concepts and tools that have been publishedinto reality, a reality that can be measured and studied.The article by Roffi et al. fills in a significant part ofthe pieces that are missing. It emphasizes the crucialnature of developing a system that includes specificpatient protocols, training of the physicians involved,involvement of Neurology and paramedical staff, andcareful follow up of patients. With such attention toexperience and detail, interventional cardiology canbegin to alleviate the concerns raised by studies suchas EVA-3S [1] and can take its place firmly as a partof the treatment strategy for patients with carotid ar-tery stenosis who face the concern about that mostdevastating cardiovascular complication of all—stroke.

REFERENCE

1. Mas JL, Chatellier G, Beyssen B, et al. Endarterectomy versus

stenting in patients with symptomatic severe carotid stenosis.

N Engl J Med 2006;355:1660–1671.

Correspondence to: David R. Holmes, MD, 200 First Street SW,

Rochester, MN 55905. E-mail: holmes.david@mayo.edu

Received 10 January 2008; Revision accepted 11 January 2008

DOI 10.1002/ccd.21519

Published online 25 February 2008 in Wiley InterScience (www.

interscience.wiley.com).

' 2008 Wiley-Liss, Inc.

Catheterization and Cardiovascular Interventions 71:474 (2008)