Current management of extracranial carotid artery disease.
Stroke is the third most common cause of death in the United States. There are approximately 700,000 strokes/year, eighty percent are ischemic, and 20-30% of ischemic strokes are secondary to carotid disease. Carotid stenosis is traditionally treated by carotid endarterectomy (CEA). Multicenter randomized controlled trials have shown that surgery significantly reduces the risk of ipsilateral stroke in patients with severe symptomatic and asymptomatic carotid stenosis. Endovascular techniques for treating carotid stenosis have been developed over recent years. Carotid angioplasty and stenting (CAS) with cerebral protection has become an alternative to CEA for high-surgical-risk patients and the procedure of choice for stenoses inaccessible by surgery. In this review we summarize the existing data regarding the traditional state of management of extracranial carotid artery stenosis, and compare these data to a critical analysis of the recent results of CAS.
Chaer
Rabih A
RA
New York Presbyterian Hospital, Division of Vascular Surgery, Cornell University, Weill Medical College, NY, USA.
DeRubertis
Brian
B
Patel
Sheela
S
Lin
Stephanie C
SC
Kent
Craig K
CK
Faries
Peter L
PL
D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery / Q000628:therapy*; D002404:Catheterization; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005374:Filtration; D006801:Humans; D018810:Magnetic Resonance Angiography; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D018616:Ultrasonography, Doppler, Duplex