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Recent Update on Carotid Endarterectomy versus Carotid Artery Stenting

Raywat Noiphithak1, Anusak Liengudom

  • 1Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.

Cerebrovascular Diseases (Basel, Switzerland)
|November 30, 2016
PubMed

Insights

Carotid artery stenosis (CS) management involves best medical treatment and revascularization (CEA/CAS). This review compares CEA and CAS efficacy and safety, proposing a new decision-making framework for CS patients.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Carotid artery stenosis (CS) is a primary cause of ischemic stroke.
  • Current management includes best medical treatment and carotid revascularization (CR) via carotid endarterectomy (CEA) or carotid artery stenting (CAS).
  • Both CR methods carry procedural risks, complicating patient selection.

Purpose of the Study:

  • To review and compare current evidence on the efficacy and safety of CEA versus CAS for CS.
  • To analyze data from randomized trials, meta-analyses, and ongoing trials.
  • To propose a novel, comprehensive decision-making strategy for CS management.

Main Methods:

  • Systematic review of existing literature.
  • Comparative analysis of randomized controlled trials and meta-analyses.
  • Inclusion of data from ongoing clinical trials.

Main Results:

  • Evidence regarding the comparative efficacy and safety of CEA and CAS remains controversial.
  • Existing studies and guidelines offer varying recommendations for symptomatic and asymptomatic patients.
  • Ongoing trials are crucial for resolving current therapeutic debates.

Conclusions:

  • A nuanced approach is required for selecting optimal treatment for CS.
  • The proposed decision-making framework aims to integrate current data for improved patient outcomes.
  • Further research and trial data are essential for definitive treatment guidelines.

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