Optimal treatment of carotid artery disease.
Extracranial carotid artery disease accounts for approximately 25% of ischemic strokes. Although carotid endarterectomy (CEA) is the established gold standard for carotid revascularization, carotid artery angioplasty and stenting (CAS) is continually developing into a safer and more efficacious method of stroke prevention. Embolic protection, improving stent designs, and ever-increasing surgeon experience are propelling CAS towards equipoise with and possible superiority to CEA. One multicenter randomized trial and several nonrandomized registries have successfully established CAS as an accepted treatment for high-risk patients. Clinicians must strive to perform well-designed clinical trials that will continue to aid understanding and improve application of both endovascular and open techniques for extracranial carotid revascularization. We review the data published to date regarding the indications for and recent developments in the use of CAS.
Levy
Elad I
EI
Department of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York 14209, USA. elevy@buffns.com
Mocco
J
J
Samuelson
Rodney M
RM
Ecker
Robert D
RD
Jahromi
Babak S
BS
Hopkins
L Nelson
LN
D000800:Angioplasty, Balloon; D002340:Carotid Artery Diseases / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid; D006801:Humans; D015607:Stents; D020521:Stroke / Q000517:prevention & control