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Management of carotid artery stenosis: comparing endarterectomy and stenting
Ricardo A Hanel1, Andrew R Xavier, Jawad F Kirmani
1Department of Neurosurgery, Millard Fillmore Hospital, 3 Gates Circle, Buffalo, NY 14209-1194, USA.
Insights
Stroke, a leading cause of death and disability, affects 750,000 annually. Carotid artery stenosis is a major risk factor, but treatments like carotid endarterectomy (CEA) and angioplasty with stenting (CAS) can reduce stroke risk.
Area of Science:
- Vascular Neurology
- Interventional Cardiology
Background:
- Stroke is a leading cause of death and disability, with significant economic impact.
- Cervical internal carotid artery occlusive disease accounts for approximately 25% of ischemic strokes.
- Carotid stenosis increases stroke risk through embolism and hypoperfusion.
Purpose of the Study:
- To review the established role of carotid endarterectomy (CEA) in stroke risk reduction.
- To introduce carotid angioplasty and stenting (CAS) as a contemporary alternative to CEA.
- To highlight patient populations where CAS may be preferred over CEA.
Main Methods:
- Review of landmark clinical trials including NASCET, ECST, and ACAS.
- Discussion of the evolution and application of carotid angioplasty and stenting (CAS).
- Comparative analysis of CEA and CAS in managing carotid stenosis.
Main Results:
- CEA has demonstrated substantial stroke risk reduction in specific grades of carotid stenosis.
- CAS has emerged as a viable alternative to CEA.
- CAS may be particularly beneficial for patients with increased CEA complication risks.
Conclusions:
- Carotid endarterectomy remains a proven intervention for select patients with symptomatic carotid stenosis.
- Carotid angioplasty and stenting offers a valuable alternative, especially in high-risk surgical candidates.
- Both CEA and CAS play crucial roles in managing carotid atherovascular disease to prevent ischemic stroke.
Abstract:
Stroke ranks as the third leading cause of death, behind diseases of the heart and cancer. It is also the most important cause of disability. Approximately 750,000 people experience a stroke annually, costing an estimated $40 billion in direct and indirect costs. Approximately 25% of these ischemic events are related to occlusive disease of the cervical internal carotid artery. Carotid atherovascular stenosis increases the risk of ischemic stroke by acting as an embolic source, and causing hypoperfusion of the ipsilateral cerebral hemisphere. With some limitations, the North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trialists' Collaborative Group (ECST), and Asymptomatic Carotid Atherosclerosis Study (ACAS) have shown that carotid endarterectomy (CEA) substantially reduces the risk of stroke associated with certain grades of carotid stenosis. During the past few years, carotid angioplasty and stenting (CAS) has evolved as an alternative to CEA, particularly in patients who are known to have a higher complication rate with CEA.