Carotid artery disease: should angioplasty be considered an alternative to open carotid surgery?
The importance of treating symptomatic high-grade stenosis of the carotid artery is now widely acknowledged. The criteria for nonmedical treatment is continually refined by taking into account the patient's symptoms, age, gender, family history, and treatment-related risk factors. Such refinements have realized importance because the small benefit of invasive treatment can be negated by treatment complications. Improvements in medical treatments such as novel antiplatelet agents, antioxidant, and statin therapy, will ensure that the gain from invasive methods will be further reduced. Surgical (open) carotid endarterectomy (CEA) is the gold standard treatment for high-risk lesions, because it achieves the crucial goal of excising the culprit atheroma, thus providing treatment durability. However, this treatment is highly dependent on surgical standards, and therefore, it may not be beneficial in all centers. In carotid angioplasty (CAP), the atheroma is distended with an endovascular balloon. Because the atheroma is not removed, but the pathologic process is altered, durability cannot be assumed and restenosis remains a significant possibility. In this article, the areas of concern for CEA and CAP will be compared and contrasted. I will address the standards of care used when treating patients with carotid artery disease, and discuss the procedure that should be followed when introducing new treatment options.
Kirkpatrick
P J
PJ
University Department of Neurosurgery, Addenbrookes' Hospital, Cambridge, United Kingdom.
D000800:Angioplasty, Balloon; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D002340:Carotid Artery Diseases / Q000601:surgery* / Q000628:therapy*; D016893:Carotid Stenosis / Q000601:surgery* / Q000628:therapy*; D016894:Endarterectomy, Carotid; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D000975:Antioxidants; D010975:Platelet Aggregation Inhibitors