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A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
09:36

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

Current concepts in the management of carotid stenosis

Norman R Hertzer1

  • 1Cleveland Clinic Emeritus Office 3050 Science Park Drive (AC334), Beachwood, OH 44122 USA.

F1000 Medicine Reports
|October 16, 2010
PubMed

Insights

Carotid endarterectomy significantly improves stroke prevention compared to medical management alone for severe carotid stenosis. Percutaneous angioplasty is an alternative for high-risk patients or within clinical trials.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Cardiovascular Medicine

Background:

  • Severe carotid stenosis poses a significant stroke risk.
  • Carotid endarterectomy (CEA) has been established as a treatment option.
  • Medical management alone is a baseline comparison for interventions.

Purpose of the Study:

  • To review the established efficacy of carotid endarterectomy for stroke prevention.
  • To discuss percutaneous carotid angioplasty (PCA) as an alternative treatment.
  • To define the current role of CEA and PCA in managing carotid stenosis.

Main Methods:

  • Review of large randomized clinical trials (RCTs) conducted in North America and Europe.
  • Analysis of comparative effectiveness between CEA plus medical management and medical management alone.
  • Evaluation of percutaneous carotid angioplasty as a treatment modality.

Main Results:

  • RCTs demonstrated that CEA plus medical management is superior to medical management alone for stroke prevention.
  • This benefit was observed in both symptomatic and asymptomatic patients with severe carotid stenosis.
  • Percutaneous carotid angioplasty is emerging as another viable treatment option.

Conclusions:

  • Carotid endarterectomy remains a proven intervention for stroke prevention in severe carotid stenosis.
  • Percutaneous carotid angioplasty is best suited for patients unsuitable for surgery or within clinical trials.
  • Optimal treatment strategy depends on patient-specific risk factors and trial participation.

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