The role of carotid revascularization in stroke prevention

The goal of carotid disease management is prevention of stroke. Many randomized prospective trials of carotid disease management provide level-1 evidence to guide decision making to optimize stroke prevention in patients with carotid disease. Other patients present with clinical scenarios that fall outside the eligibility criteria for these clinical trials, and in these patients, clinical decisions must be based on the best available information on the natural history of each patient's carotid disease and on the clinician's assessment of the risks and benefits of intervention. In this monograph, the author reviews the current clinical data relating to carotid revascularization for asymptomatic carotid disease, for carotid disease with transient ischemic attack or minor stroke, and for carotid disease with acute stroke or stroke in evolution. Relevant clinical trials of carotid endarterectomy and carotid stenting are reviewed in detail. In addition, relevant natural history and risk-benefit data are reviewed to guide clinical decision making in patients whose clinical presentations fall outside the scope of the available clinical trials. The goal of this monograph is to provide the clinician with an evidence basis for clinical decision making in patients with commonly encountered carotid disease-related presentations.