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Updated: Jan 5, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
CEA vs. stent in patients with acute strokes: are they equally effective?
Xzabia Caliste1, Adriana Laser2, R Clement Darling1
1Division of Vascular Surgery, Albany Medical Center Hospital, Albany Medical College, Albany, NY, USA.
Insights
Carotid endarterectomy is effective for acute stroke management. While carotid stenting shows promise in select patients, endarterectomy remains a proven safe option for reducing stroke risk.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Stroke is a leading global cause of death, with extracranial carotid stenosis a major contributor to ischemic strokes.
- Secondary stroke reduction strategies include carotid endarterectomy and carotid stenting for acute stroke patients.
- This review compares the available data on the equivalency of these two intervention options.
Purpose of the Study:
- To review and compare the efficacy and safety of carotid endarterectomy versus carotid stenting for secondary stroke reduction in patients with acute symptomatic carotid stenosis.
Main Methods:
- A comprehensive literature review was conducted using PubMed and other sources.
- Keywords included: carotid endarterectomy, carotid artery stent, acute stroke, symptomatic carotid stenosis, flow reversal, TCAR.
- Studies focused on asymptomatic disease were excluded.
Main Results:
- Landmark trials (NASCET, CREST) and recent studies confirm the effectiveness of carotid endarterectomy for acute stroke.
- Carotid stenting demonstrates acceptable outcomes in specific patient cohorts.
- Carotid endarterectomy remains a highly effective and safe intervention.
Conclusions:
- Carotid endarterectomy is a safe and effective treatment for acute stroke management.
- Carotid stenting has limitations but is non-inferior in certain populations.
- Technological advancements may broaden patient selection criteria for carotid stenting in the future.
Introduction:
Stroke is the 3rd leading cause of death worldwide with 15 million strokes annually. Extracranial carotid stenosis contributes to major stroke morbidity and mortality as a significant etiology of ischemic strokes. For acute stroke, in addition to optimal medical management, patients may be candidates for carotid endarterectomy and/or carotid stenting for secondary stroke reduction. This paper set out to review the data currently available regarding equivalency of the two intervention options.
Evidence Acquisition:
A comprehensive literature review was performed through PubMed and other sources using the key words carotid endarterectomy, carotid artery stent, acute stroke, symptomatic carotid stenosis, flow reversal, TCAR. Studies which solely evaluated patients with asymptomatic disease were ineligible for the study.
Evidence Synthesis:
Review of landmark trials such as NASCET and CREST in addition to more recent studies demonstrates the effectiveness of surgical management with carotid endarterectomy of acute stroke. Carotid stenting has also been shown to have acceptable outcomes in certain patient populations.
Conclusions:
Carotid endarterectomy continues to demonstrate effectiveness and safety for management of acute stroke, while carotid stenting has limitations. Carotid artery stenting has been shown to be non-inferior in some patient populations, but more recent and future technologic developments may expand the potential acceptable patient selection criteria.
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