Diagnostic workup in carotid stenosis-a neurologist's perspective.
Carotid artery stenosis is associated with the risk of stroke, myocardial infarction, and vascular death. In selected patients, revascularization of carotid narrowing by endarterectomy may reduce the risk of stroke distal to the stenosis. Carotid artery stenting has evolved as a potential alternative to endarterectomy. Four randomized clinical trials comparing safety and efficacy of endarterectomy versus stenting of symptomatic carotid stenosis have been published in recent years, but there remains some uncertainty about the implications of these trials for clinical routine. Both carotid stenting and endarterectomy are based on different treatment strategies which may result in different specific risk factors associated with each procedure. Hence, the procedural risk of either modality varies not only with the skills of the surgeon or the interventionalist but may depend on patient characteristics. It appears that the most important question is not whether one revascularization modality is superior but for which patient one modality is better than the other. A comprehensive diagnostic workup of patients with carotid stenosis based on a broad panel of covariates that affect the risk of vascular events may improve selection of patients for carotid revascularization and may help to decide for whom one revascularization modality is likely to be better than the other.
Rosenkranz
Michael
M
Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. rosenkranz@uke.de
Gerloff
Christian
C
D000367:Age Factors; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D015897:Comorbidity; D006801:Humans; D009460:Neurologic Examination / Q000379:methods; D018579:Patient Selection; D012720:Severity of Illness Index; D012737:Sex Factors
Cerebrovasc Dis. 2009;28(6):601-10
19844101
Neurology. 2004 Feb 24;62(4):569-73
14981172
Lancet. 2006 May 6;367(9521):1503-12
16679163
Stroke. 2000 Mar;31(3):622-30
10700495
Stroke. 1994 Feb;25(2):304-8
8303736
Neuroradiology. 2010 Feb;52(2):75-82
19727693
Eur J Vasc Endovasc Surg. 1996 May;11(4):414-6
8846173
Lancet. 2004 May 8;363(9420):1491-502
15135594
Cerebrovasc Dis. 2007;24 Suppl 1:116-25
17971647
Stroke. 1999 Feb;30(2):282-6
9933260
JAMA. 1995 May 10;273(18):1421-8
7723155
Stroke. 2010 Jan;41(1):e11-7
19926843
Lancet. 1999 Nov 6;354(9190):1594-7
10560674
Neuroradiology. 2010 Apr;52(4):253-74
20155353
Lancet. 2003 Jan 11;361(9352):107-16
12531577
Lancet. 2007 Jan 27;369(9558):283-92
17258668
Stroke. 1994 Apr;25(4):759-65
8160217
Stroke. 1999 Jul;30(7):1440-3
10390320
Circulation. 2001 Jul 3;104(1):68-73
11435340
Cerebrovasc Dis. 2009;27(5):443-9
19295207
Stroke. 2009 Nov;40(11):3511-7
19729602
Neurol Res. 2005;27 Suppl 1:S18-28
16197820
Lancet. 2007 Oct 20;370(9596):1432-42
17928046
JAMA. 2000 Dec 13;284(22):2901-6
11147987
Neurology. 2000 Jul 25;55(2):307-9
10908914
AJNR Am J Neuroradiol. 2005 Sep;26(8):2086-94
16155163
BMJ. 1997 Dec 13;315(7122):1571-7
9437274
Radiology. 1993 Feb;186(2):316-8
8421726
Lancet. 2004 Sep 25-Oct 1;364(9440):1122-3; author reply 1125-6
15451212
Stroke. 1995 Nov;26(11):2184-6
7482670
J Vasc Surg. 1993 Dec;18(6):1002-9; discussion 1009-11
8264028
Cerebrovasc Dis. 2005;20(2):69-77
15976498
Neurology. 1995 Mar;45(3 Pt 1):428-31
7898689
Lancet. 2001 Apr 14;357(9263):1154-60
11323042
Circulation. 2001 May 1;103(17):2171-5
11331258
Stroke. 2003 Sep;34(9):2290-301
12920260
Lancet. 2005 Jul 2-8;366(9479):29-36
15993230
N Engl J Med. 1991 Aug 15;325(7):445-53
1852179
N Engl J Med. 1998 Nov 12;339(20):1415-25
9811916
N Engl J Med. 2006 Oct 19;355(16):1660-71
17050890
Lancet Neurol. 2008 Mar;7(3):216-22
18242141
Lancet. 1991 May 25;337(8752):1235-43
1674060
Lancet. 2010 Mar 20;375(9719):985-97
20189239
Lancet. 2006 Oct 7;368(9543):1239-47
17027729
Circulation. 2005 May 3;111(17):2233-40
15851601
J Neurol Neurosurg Psychiatry. 1993 Sep;56(9):967-72
8410036
Neurology. 2005 Aug 9;65(3):371-5
16087900
J Neurosurg. 1995 Nov;83(5):778-82
7472542
Int J Stroke. 2009 Aug;4(4):294-9
19689759
Lancet. 2000 Jan 1;355(9197):19-24
10615886
Lancet. 2004 Mar 20;363(9413):915-24
15043958
Stroke. 2005 May;36(5):971-5
15817897
Health Technol Assess. 2006 Aug;10(30):iii-iv, ix-x, 1-182
16904049
Arch Neurol. 1995 Mar;52(3):246-9
7872876
Stroke. 2000 Mar;31(3):615-21
10700494
JAMA. 2000 Mar 15;283(11):1429-36
10732932
Stroke. 2007 Nov;38(11):2985-91
17901388
Neuroradiology. 2008 Dec;50(12):1049-53
18810400
Cardiovasc Surg. 1999 Jan;7(1):33-8
10073757
Arch Neurol. 2001 Sep;58(9):1410-3
11559312
Stroke. 2006 Dec;37(12):3032-4
17053182
J Vasc Surg. 2008 Jul;48(1):104-12; discussion 112-3
18486416
Eur J Vasc Endovasc Surg. 2001 Apr;21(4):301-10
11359329
J Neurol. 2007 Dec;254(12):1714-22
17994312
Stroke. 1999 Sep;30(9):1751-8
10471419
Semin Vasc Surg. 2000 Jun;13(2):139-43
10879554
Neuroradiology. 2010 Apr;52(4):285-90
20020115
Stroke. 2000 Mar;31(3):774-81
10700518
Lancet. 1998 May 9;351(9113):1379-87
9593407
Neuroradiology. 2010 Apr;52(4):275-83
19936732
Stroke. 1998 Oct;29(10):2125-8
9756593
Neurology. 2000 Feb 8;54(3):660-6
10680800
Circulation. 2004 Aug 10;110(6):756-62
15277320
Arch Neurol. 2010 Feb;67(2):180-6
20008646
Stroke. 1994 Dec;25(12):2403-6
7974580
Neurology. 1997 Apr;48(4):911-5
9109876
Circulation. 1998 Jan 6-13;97(1):34-40
9443429