Secondary stroke prevention in the era of carotid stenting: update on recent trials
Heitham T Hassoun1, Mahmoud B Malas, Julie A Freischlag
1Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. hhassoun@tmhs.org
Insights
Carotid artery stenting (CAS) offers an alternative to carotid endarterectomy (CEA) for stroke risk reduction. Current data and ongoing trials are crucial for understanding CAS effectiveness and controversy in treating extracranial carotid artery disease.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Stroke remains a significant global health burden, with extracranial carotid artery occlusive disease being a major risk factor.
- Carotid endarterectomy (CEA) has been the traditional surgical treatment for reducing stroke risk in these patients.
- Percutaneous interventions, inspired by coronary artery disease treatments, have led to the development of carotid artery stenting (CAS) as an alternative to CEA.
Purpose of the Study:
- To review available data comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA) for stroke risk reduction.
- To provide an overview of ongoing large randomized trials evaluating CAS as an alternative therapy.
- To address the ongoing controversy surrounding CAS in the context of modern medical interventions.
Main Methods:
- Review of existing single-center studies and industry-sponsored stent registries demonstrating CAS outcomes.
- Comparison of CAS results with landmark randomized carotid endarterectomy (CEA) trials.
- Analysis of data considering advancements in CAS techniques and patient selection criteria.
Main Results:
- Single-center studies and registries suggest excellent results for CAS, particularly with increased operator experience.
- CAS outcomes are being compared against historical CEA trial data.
- Recent European randomized trials have added to the controversy surrounding CAS.
Conclusions:
- Carotid artery stenting (CAS) is a developing alternative to carotid endarterectomy (CEA) for stroke prevention.
- The efficacy and safety of CAS compared to CEA are subjects of ongoing debate and research.
- Large randomized trials are anticipated to provide definitive data on the role of CAS in managing extracranial carotid artery disease.
Abstract:
Stroke is a leading cause of morbidity and mortality worldwide. Traditional therapy for extracranial carotid artery occlusive disease, a significant risk factor for stroke, consists of optimal medical management and selective surgical treatment with carotid endarterectomy (CEA) for stroke risk reduction. Buoyed by the widespread application of percutaneous interventions for the treatment of coronary artery disease, carotid artery stenting (CAS) has steadily developed during the past decade as an alternative to CEA for patients who might benefit from surgical treatment. With greater operator experience have come advances in CAS techniques and patient selection criteria, and several single-center studies and industry-sponsored stent registries have demonstrated excellent results for CAS, especially compared with the landmark randomized CEA trials of the 1980s. Nevertheless, CAS has emerged as one of the most controversial procedures in the era of modern medicine, and recently published randomized trials from Europe have only stoked the fires of controversy. This study reviews the best available data for CAS as an alternative therapy to CEA for stroke risk reduction and gives an overview of eagerly anticipated large randomized trials.
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