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A Rat Carotid Balloon Injury Model to Test Anti-vascular Remodeling Therapeutics

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The Evolution of Carotid Surgery.

Viren S Sehgal¹, Windsor Ting¹

¹Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.

Annals of Vascular Surgery

|September 29, 2024

Summary

This review details the historical development of carotid surgery, from early ligation attempts to modern endarterectomy and stenting techniques. It highlights key innovations and clinical trials that shaped current best practices for treating carotid artery stenosis.

Area of Science:

Vascular Surgery
Cerebrovascular Disease
Medical History

Background:

The carotid arteries are crucial for cerebral blood supply, and their stenosis is a major cause of ischemic stroke.
Historical understanding of the carotid arteries' role in stroke evolved significantly from the 17th century onwards.

Purpose of the Study:

To review the historical evolution of carotid surgery techniques.
To examine the advancements in treating carotid artery stenosis.
To discuss the current landscape and future directions in carotid revascularization.

Main Methods:

Historical literature review tracing the development of carotid surgery.
Analysis of key surgical innovations and clinical trials.
Discussion of emerging endovascular and hybrid techniques.

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Main Results:

Early carotid ligation attempts were followed by the development of carotid endarterectomy (CEA) in the mid-20th century.
Innovations like patch angioplasty and shunting improved CEA outcomes, establishing it as a standard treatment.
Carotid artery stenting (CAS) emerged as a less invasive alternative, with newer techniques like TCAR gaining traction.

Conclusions:

Carotid surgery has evolved from basic ligation to sophisticated endovascular and open surgical procedures.
CEA remains a cornerstone, but CAS and TCAR offer alternative revascularization strategies.
Personalized treatment for carotid artery stenosis is advancing through research into plaque morphology and diagnostics.