Carotid stenting and endarterectomy

Area of Science:

• Cardiovascular Medicine
• Interventional Neurology
• Vascular Surgery

Background:

• Stroke is a leading global cause of death, with ischemic stroke (IS) often resulting from carotid artery stenosis (CAS).
• Medical management with anti-platelet agents can reduce long-term IS incidence in CAS patients.
• Carotid endarterectomy (CEA) is effective for symptomatic CAS but has limitations.

Purpose of the Study:

• To review and critically analyze various interventional approaches for treating carotid artery stenosis (CAS).
• To highlight the evolution of endovascular techniques for CAS intervention.
• To discuss the advantages and limitations of different carotid stenting approaches.

Main Methods:

• Review of clinical trials and existing literature on carotid artery stenosis interventions.
• Comparison of carotid endarterectomy (CEA) with medical therapy and percutaneous stenting.
• Evaluation of transfemoral, transradial, and transbrachial arterial approaches for carotid stenting.

Main Results:

• Carotid endarterectomy (CEA) is superior to medical therapy for symptomatic CAS in preventing IS.
• Percutaneous transfemoral carotid stenting shows comparable outcomes to CEA but has specific patient limitations.
• Transradial/transbrachial arterial approaches represent a novel and emerging alternative for carotid stenting.

Conclusions:

• Interventional strategies for CAS have evolved, offering alternatives to traditional CEA.
• Transradial/transbrachial carotid stenting presents a promising option for select patient populations.
• Optimal treatment selection for CAS requires careful consideration of patient anatomy and procedural risks.