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A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
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Symptomatic carotid stenosis: is stenting as safe and effective as carotid endarterectomy?

David Calvet1, Jean-Louis Mas,

  • 1Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, DHU Neurovasc Sorbonne Paris Cité, INSERM U894, Paris, France.

Current Opinion in Neurology
|December 22, 2016
PubMed

Insights

Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are equally effective for preventing recurrent stroke. CAS has higher procedural risks but is a safe alternative for select patients, especially those under 70.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Interventional Cardiology

Background:

  • Symptomatic carotid stenosis poses a significant risk of ipsilateral stroke.
  • Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are primary interventions to prevent stroke in these patients.
  • Comparative evidence between CAS and CEA is crucial for clinical decision-making.

Purpose of the Study:

  • To review current evidence comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA).
  • To evaluate the efficacy and safety of both procedures in preventing ipsilateral stroke in patients with symptomatic carotid stenosis.

Main Methods:

  • Systematic review of randomized clinical trials and registries.
  • Analysis of individual patient data from the Carotid Stenosis Trialists' Collaboration.

Main Results:

  • CAS is associated with a higher risk of procedural stroke or death compared to CEA.
  • CAS shows a lower risk of procedural myocardial infarction and local complications.
  • Both CAS and CEA demonstrate equal effectiveness in preventing late recurrent ipsilateral stroke.
  • Restenosis rates are similarly low for both procedures.
  • Individual patient data confirmed CAS safety and efficacy in patients younger than 70.

Conclusions:

  • Carotid endarterectomy (CEA) remains the standard treatment for symptomatic carotid stenosis.
  • Carotid artery stenting (CAS) is a safe and effective alternative, particularly for patients under 70.
  • CAS can be considered when CEA is contraindicated.
Abstract

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