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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Vascular intervention in stroke prevention: endarterectomy and angioplasty

Jörg Ederle1, Martin M Brown

  • 1Stroke Research Group, UCL Institute of Neurology, London, UK.

Cerebrovascular Diseases (Basel, Switzerland)
|April 4, 2009
PubMed

Insights

Carotid endarterectomy effectively treats severe symptomatic carotid stenosis, but its benefit diminishes with moderate stenosis or asymptomatic cases. Routine carotid stenting is not yet justified for patients eligible for surgery.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Cardiovascular Medicine

Background:

  • Carotid stenosis is a significant risk factor for stroke and transient ischemic attack.
  • Treatment strategies differ for symptomatic versus asymptomatic carotid stenosis.
  • Carotid endarterectomy is a primary surgical intervention for severe symptomatic stenosis.

Purpose of the Study:

  • To review the efficacy of carotid endarterectomy and endovascular treatment for carotid stenosis.
  • To evaluate the impact of timing and severity on treatment outcomes.
  • To determine the current role of carotid stenting versus endarterectomy.

Main Methods:

  • Review of landmark randomized trials on carotid endarterectomy.
  • Analysis of data from early and subsequent trials of endovascular treatment (carotid stenting).
  • Consideration of improvements in medical management, including statin therapy.

Main Results:

  • Carotid endarterectomy is beneficial for severe symptomatic stenosis, especially when performed within two weeks of symptom onset.
  • Benefits are reduced for moderate stenosis and potentially harmful for stenosis less than 50%.
  • Current evidence does not support routine carotid stenting as a substitute for endarterectomy in surgical candidates.

Conclusions:

  • Carotid endarterectomy remains the standard for select symptomatic severe carotid stenosis patients.
  • Asymptomatic carotid stenosis generally does not warrant routine surgical intervention due to limited benefits.
  • Further randomized trials are necessary to establish the definitive role of carotid stenting.

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