Evidence-based treatment of carotid artery stenosis

Kate C. Young, Anunaya Jain, Minal Jain, Robert E. Replogle, Curtis G. Benesch, Babak S. Jahromi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Carotid atheromatous disease is an important cause of stroke. Carotid endarterectomy (CEA) is a well-established option for reducing the risk of subsequent stroke due to symptomatic stenosis (> 50%). With adequately low perioperative risk (< 3%) and sufficient life expectancy, CEA may be used for asymptomatic stenosis (> 60%). Recently, carotid angioplasty and stent placement (CAS) has emerged as an alternative revascularization technique. Trial design considerations are discussed in relation to trial results to provide an understanding of why some trials were considered positive whereas others were not. This review then addresses both the original randomized studies showing that CEA is superior to best medical management and the newer studies comparing the procedure to stent insertion in both symptomatic and asymptomatic populations. Additionally, recent population-based studies show that improvements in best medical management may be lowering the stroke risk for asymptomatic stenosis. Finally, the choice of revascularization technique is discussed with respect to symptom status. Based on current evidence, CAS should remain limited to specific indications.

Original languageEnglish (US)
Article numberE2
JournalNeurosurgical focus
Volume30
Issue number6
DOIs
StatePublished - Jun 1 2011

Keywords

  • Carotid angioplasty and stent placement
  • Carotid endarterectomy
  • Evidence-based medicine

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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