Patient selection for revascularization in cervical carotid artery disease: angioplasty and stenting vs. endarterectomy.
Cervical carotid stenosis is a major cause of stroke and disability. Although carotid endarterectomy is an established and effective treatment for some patients with carotid artery stenosis, angioplasty and stenting has emerged in recent years as a viable alternative, particularly for patients who may be less suited for surgery. This article reviews patient selection for the two alternative approaches. The authors review the findings of the major clinical trials of carotid endarterectomy, summarize the development of carotid angioplasty and stenting, and identify patient characteristics that may guide selection of surgical or endovascular treatment.
Harrigan
Mark R
MR
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14209, USA.
Howington
Jay U
JU
Hanel
Ricardo A
RA
Guterman
Lee R
LR
Hopkins
L Nelson
LN
D000792:Angiography; D017130:Angioplasty / Q000009:adverse effects / Q000592:standards* / Q000639:trends; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D006233:Persons with Disabilities; D016894:Endarterectomy, Carotid / Q000592:standards* / Q000639:trends; D005544:Forecasting; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000453:epidemiology / Q000209:etiology; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012042:Registries; D012107:Research Design; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects / Q000592:standards*; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome