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Updated: May 20, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Carotid artery stenting
Leo H Bonati1, Stefan T Engelter, Philippe A Lyrer
1Department of Neurology and Stroke Unit, University Hospital Basel, CH-4031 Basel, Switzerland. bonatil@uhbs.ch
Insights
Carotid endarterectomy (CEA) shows lower peri-procedural stroke risk than carotid artery stenting (CAS). CAS is safer for younger patients, while CEA is preferred for elderly individuals regarding stroke risk.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Internal carotid artery stenosis is a significant cause of ischemic stroke.
- Carotid endarterectomy (CEA) is a proven stroke risk reduction therapy.
- Carotid artery stenting (CAS) offers an endovascular alternative to CEA.
Purpose of the Study:
- To review and compare the risks and benefits of CAS versus CEA.
- To focus on evidence derived from randomized clinical trials.
- To assess the safety and efficacy of CAS as an alternative to CEA.
Main Methods:
- Systematic review of randomized clinical trials comparing CAS and CEA.
- Analysis of peri-procedural complications and long-term outcomes.
- Stratification of results based on patient age and symptomatic status.
Main Results:
- CEA demonstrated a lower risk of peri-procedural stroke or death compared to CAS.
- CAS was associated with reduced risks of myocardial infarction, cranial nerve palsy, and access site hematoma.
- CAS is a potentially safer option for younger patients, whereas elderly patients face higher stroke risks with CAS.
Conclusions:
- CEA has a lower peri-procedural stroke risk than CAS.
- CAS offers specific advantages in reducing certain complications, particularly in younger patient populations.
- Long-term effectiveness and optimal treatment for asymptomatic stenosis require further investigation through ongoing trials.
Abstract:
Atherosclerotic narrowing (stenosis) of the internal carotid artery accounts for about 10-15% of ischaemic strokes. Carotid endarterectomy (CEA) reduces the risk of stroke in patients with symptomatic stenosis and - to a lesser degree - with asymptomatic carotid stenosis. Endovascular treatment including balloon angioplasty and carotid artery stenting (CAS) has emerged as an alternative to CEA to treat carotid stenosis. The present review summarises the existing evidence on risks and benefits of CAS in comparison with CEA, with a focus on evidence from randomised clinical trials. Across all randomised trials, CEA was associated with a lower risk of peri-procedural stroke or death than CAS, while CAS had lower risks of myocardial infarction, cranial nerve palsy and access site haematoma. The increased stroke risk with CAS is mainly observed in elderly patients; therefore, CAS appears to be a safe option to CEA in younger patients. In the first few years following treatment, both procedures are equally effective in preventing ipsilateral recurrent strokes. Nevertheless, long-term follow-up of ongoing trials must be awaited to investigate whether a potential increase in recurrent stenosis following CAS might limit the long-term effectiveness in stroke prevention. The optimal treatment for asymptomatic carotid stenosis remains to be determined in ongoing clinical trials.
