What Is the Best Technique for Treating Carotid Disease?

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Neurology

Background:

• Carotid artery disease poses a significant stroke risk.
• Surgical and endovascular techniques aim to restore blood flow.
• Choosing the optimal revascularization strategy is critical for patient outcomes.

Purpose of the Study:

• To comprehensively review and compare Carotid Endarterectomy (CEA), Transfemoral Carotid Artery Stenting (TFCAS), and Transcarotid Artery Revascularization (TCAR).
• To evaluate the safety and efficacy of each technique, particularly in high-risk patient populations.
• To inform clinical decision-making for carotid artery revascularization.

Main Methods:

• Systematic review of existing literature on CEA, TFCAS, and TCAR.
• Comparative analysis of procedural outcomes, including stroke rates, mortality, and neuroprotection.
• Assessment of patient-specific factors influencing technique selection.

Main Results:

• Carotid Endarterectomy (CEA) remains a gold standard, especially for elderly and high-risk individuals.
• Transfemoral Carotid Artery Stenting (TFCAS) is less invasive but associated with higher periprocedural stroke risks.
• Transcarotid Artery Revascularization (TCAR) combines minimally invasive advantages with neuroprotection, demonstrating comparable efficacy to CEA and superior outcomes to TFCAS in high-risk patients.

Conclusions:

• TCAR represents a promising and safer option for high-risk patients undergoing carotid revascularization.
• Patient comorbidities and anatomical considerations are crucial in selecting the most appropriate revascularization strategy.
• Further research may refine optimal patient selection criteria for each technique.